Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA.
Contraception. 2021 Aug;104(2):194-201. doi: 10.1016/j.contraception.2021.02.011. Epub 2021 Feb 28.
Postpartum tubal ligation provides demonstrated benefits to women, but access to this procedure is threatened by restrictions at Catholic healthcare institutions. We aimed to understand how insured employees assign responsibility for postpartum sterilization denial and how it impacts their view of the quality of care provided.
We conducted a nationally representative, cross-sectional survey of employees at Standard and Poor's (S&P) 500 companies utilizing a dual panel drawn from Amerispeak, a probability-based research panel, and a non-probability panel. Respondents answered questions about a scenario of a woman denied a tubal ligation due to Catholic hospital policy when her employer-sponsored insurance provided no other hospital choices. Of 1113 eligible panel members, 1001 (90%) completed the survey. Weighted analysis accounted for complex survey design.
In response to the tubal ligation denial scenario, 42% of respondents rated hospital quality-of-care as poor or very poor. Sixty percent felt that something should have been done differently, with about half assigning responsibility to the religiously-affiliated hospital for not providing the procedure and half to the insurance company for not including secular hospitals in its network. Finding employers/insurance companies responsible was more common with higher education (RRR = 3.17; 95% CI: 1.58-6.33 some college; RRR = 4.26; 95% CI: 2.10-8.62 bachelor's or more) and less common among non-white respondents (RRR = 0.54; 95% CI: 0.31-0.97). Three quarters of respondents thought the employer should have intervened.
The majority of insured employees do not think women should be denied postpartum tubal ligation. They assign hospitals, insurers, and employers responsibility to remove barriers to care.
Most people who receive health insurance through a large employer disapprove of Catholic hospital restrictions when the patient's insurance restricts her hospital choice. To improve access to comprehensive reproductive care, employers and insurers should assure employees have in-network coverage of hospitals without religious restrictions.
产后输卵管结扎术为女性带来了显著的益处，但由于天主教学术医疗机构的限制，这种手术的实施受到了威胁。我们旨在了解参保员工如何认定产后绝育拒绝的责任归属，以及这如何影响他们对所提供医疗服务质量的看法。
我们对标准普尔（S&P）500 公司的员工进行了一项全国性的、横断面调查，使用了来自 Amerispeak 的双面板，该面板是一个基于概率的研究面板，以及一个非概率面板。受访者回答了一个关于女性因天主教学术医院政策而被拒绝输卵管结扎术的情景问题，而她的雇主赞助的保险没有提供其他医院选择。在 1113 名符合条件的面板成员中，有 1001 名（90%）完成了调查。加权分析考虑了复杂的调查设计。
在输卵管结扎术拒绝的情景下，42%的受访者将医院的医疗服务质量评为差或很差。60%的人认为应该有不同的做法，大约一半的人将责任归咎于宗教附属医院未提供该手术，另一半则归咎于保险公司未将世俗医院纳入其网络。发现雇主/保险公司应承担责任的情况在受教育程度较高的人群中更为常见（RRR=3.17；95%置信区间：1.58-6.33 接受过一些大学教育；RRR=4.26；95%置信区间：2.10-8.62 拥有学士或更高学历），而在非白人受访者中则较少见（RRR=0.54；95%置信区间：0.31-0.97）。四分之三的受访者认为雇主应该进行干预。
大多数参保员工认为女性不应该被拒绝产后输卵管结扎术。他们将医院、保险公司和雇主视为消除护理障碍的责任方。
大多数通过大型雇主获得健康保险的人在患者的保险限制了她的医院选择时，不赞成天主教学术医院的限制。为了改善全面生殖护理的可及性，雇主和保险公司应确保员工在网络内获得没有宗教限制的医院的覆盖。
