The Effect of Contraceptive Access Reform on Privately Insured Patients: Evidence from Delaware Contraceptive Access Now

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2023 Jan 23

PMID 36689399

Authors

Maranna Yoder

Michel Boudreaux

Affiliations

Soon will be listed here.

Abstract

Background: Many states are implementing comprehensive programs aimed at reducing persistent barriers to contraceptive care. Evidence on the effectiveness of these programs is essential for practice improvement and policy development.

Objective: To evaluate changes in the probability of initiating a contraceptive method by women with employer sponsored insurance after implementation of Delaware Contraceptive Access Now (DelCAN), a statewide initiative that aimed to increase access to long-acting reversible contraceptives (LARCs).

Design, Setting, And Participants: We used a difference-in-differences design to examine contraceptive initiation rates. Data came from IBM Marketscan and covered women age 15-44 enrolled in employer sponsored insurance. The primary outcome was insertion of a LARC, both in the overall study population and in the immediate postpartum (IPP) setting. Secondary analysis examined changes to other contraceptive method types.

Results: The cohort of 4,550,459 enrollees generated a sample of 11,888,837 person-years and 615,670 childbirth hospitalizations. Difference-in-differences estimates suggested that DelCAN was associated with a 0.3 percentage point (95% CI [0.2, 0.5], p<0.001) increase in the LARC insertion rate in the overall study population and a 0.4 percentage point increase (95% CI [0.2, 0.6], p<0.001) in the percent of births adopting IPP LARC. Associations between DelCAN and LARC insertion appeared stronger for adolescents compared to older women. Results for other method types were less consistent.

Conclusions: A comprehensive statewide program was associated with increased LARC insertion rates among enrollees with employer sponsored insurance. Understanding the effect of these programs is critical for on-going policy development for states engaged in contraceptive access reform.

Citing Articles

Examining the impact of Medicaid payments for immediate postpartum long-acting reversible contraception on the mental health of low-income mothers.

Marthey D, Rochford H, Andreyeva E Health Serv Res. 2024; 59(3):e14281.

PMID: 38205665 PMC: 11063096. DOI: 10.1111/1475-6773.14281.

Contraceptive access reform and abortion: Evidence from Delaware.

Kim T, Marthey D, Boudreaux M Health Serv Res. 2023; 58(4):781-791.

PMID: 37032478 PMC: 10315387. DOI: 10.1111/1475-6773.14156.

References

Austin P . Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009; 28(25):3083-107. PMC: 3472075. DOI: 10.1002/sim.3697. View

Marthey D, Rashid H, Xie L, Boudreaux M . An evaluation of the Be Your Own Baby public awareness campaign. Health Serv Res. 2021; 56(5):766-776. PMC: 8522570. DOI: 10.1111/1475-6773.13698. View

Malcolm N, Patterson K, Pliska E, Akbarali S, Moskosky S, Hart J . Scaling Up Evidence-Based Practices in Contraceptive Access Initiatives. Am J Public Health. 2022; 112(S5):S473-S477. PMC: 10461489. DOI: 10.2105/AJPH.2022.306824. View

Steenland M, Pace L, Cohen J . Association of Medicaid Reimbursement for Immediate Postpartum Long-acting Reversible Contraception With Infant Birth Outcomes. JAMA Pediatr. 2022; 176(3):296-303. PMC: 8749696. DOI: 10.1001/jamapediatrics.2021.5688. View

Stanek A, Bednarek P, Nichols M, Jensen J, Edelman A . Barriers associated with the failure to return for intrauterine device insertion following first-trimester abortion. Contraception. 2009; 79(3):216-20. DOI: 10.1016/j.contraception.2008.09.003. View

Pace L, Dusetzina S, Fendrick A, Keating N, Dalton V . The impact of out-of-pocket costs on the use of intrauterine contraception among women with employer-sponsored insurance. Med Care. 2013; 51(11):959-63. PMC: 6702955. DOI: 10.1097/MLR.0b013e3182a97b5d. View

Boudreaux M, Xie L, Choi Y, Roby D, Rendall M . Changes to Contraceptive Method Use at Title X Clinics Following Delaware Contraceptive Access Now, 2008-2017. Am J Public Health. 2020; 110(8):1214-1220. PMC: 7349443. DOI: 10.2105/AJPH.2020.305666. View

Carlin C, Fertig A, Dowd B . Affordable Care Act's Mandate Eliminating Contraceptive Cost Sharing Influenced Choices Of Women With Employer Coverage. Health Aff (Millwood). 2016; 35(9):1608-15. DOI: 10.1377/hlthaff.2015.1457. View

Kramer R, Gangnon R, Burns M . Provision of Immediate Postpartum Long-Acting Reversible Contraceptives Before and After Wisconsin Medicaid's Payment Change. Womens Health Issues. 2021; 31(4):317-323. DOI: 10.1016/j.whi.2021.02.009. View

10.

Castleberry N, Stark L, Schulkin J, Grossman D . Implementing best practices for the provision of long-acting reversible contraception: a survey of obstetrician-gynecologists. Contraception. 2019; 100(2):123-127. DOI: 10.1016/j.contraception.2019.03.053. View

11.

Dieguez G, Pyenson B, Law A, Lynen R, Trussell J . The cost of unintended pregnancies for employer-sponsored health insurance plans. Am Health Drug Benefits. 2015; 8(2):83-92. PMC: 4437481. View

12.

Boudreaux M, Gifford K, McDuffie M, McColl R, Kim T, Knight E . Delaware Contraceptive Access Now and Contraceptive Initiation Among Medicaid Enrollees, 2015‒2020. Am J Public Health. 2022; 112(S5):S537-S540. PMC: 10490315. DOI: 10.2105/AJPH.2022.306938. View

13.

Koch S, Paul R, Addante A, Brubaker A, Kelly J, Raghuraman N . Medicaid reimbursement program for immediate postpartum long-acting reversible contraception improves uptake regardless of insurance status. Contraception. 2022; 113:57-61. DOI: 10.1016/j.contraception.2022.05.007. View

14.

Bergin A, Tristan S, Terplan M, Gilliam M, Whitaker A . A missed opportunity for care: two-visit IUD insertion protocols inhibit placement. Contraception. 2012; 86(6):694-7. DOI: 10.1016/j.contraception.2012.05.011. View

15.

Rokicki S, Cohen J, Fink G, Salomon J, Landrum M . Inference With Difference-in-Differences With a Small Number of Groups: A Review, Simulation Study, and Empirical Application Using SHARE Data. Med Care. 2017; 56(1):97-105. DOI: 10.1097/MLR.0000000000000830. View

16.

Steenland M, Pace L, Sinaiko A, Cohen J . Medicaid Payments For Immediate Postpartum Long-Acting Reversible Contraception: Evidence From South Carolina. Health Aff (Millwood). 2021; 40(2):334-342. PMC: 9555010. DOI: 10.1377/hlthaff.2020.00254. View

17.

Caudillo M, Hurtado-Acuna C, Rendall M, Boudreaux M . Association of the Delaware Contraceptive Access Now Initiative with Postpartum LARC Use. Matern Child Health J. 2022; 26(8):1657-1666. PMC: 9055365. DOI: 10.1007/s10995-022-03433-2. View

18.

Agarwal R, Mazurenko O, Menachemi N . High-Deductible Health Plans Reduce Health Care Cost And Utilization, Including Use Of Needed Preventive Services. Health Aff (Millwood). 2017; 36(10):1762-1768. DOI: 10.1377/hlthaff.2017.0610. View

19.

Steenland M, Pace L, Sinaiko A, Cohen J . Association Between South Carolina Medicaid's Change in Payment for Immediate Postpartum Long-Acting Reversible Contraception and Birth Intervals. JAMA. 2019; 322(1):76-78. PMC: 6547092. DOI: 10.1001/jama.2019.6854. View

20.

Skracic I, Lewin A, Roy K . Evaluation of the Delaware Contraceptive Access Now (DelCAN) initiative: A qualitative analysis of site leaders' implementation recommendations. Contraception. 2021; 104(2):211-215. PMC: 8286296. DOI: 10.1016/j.contraception.2021.03.015. View