Early Impact of the Affordable Care Act on Uptake of Long-acting Reversible Contraceptive Methods.
Early Impact of the Affordable Care Act on Uptake of Long-acting Reversible Contraceptive Methods.
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DOI：
10.1097/mlr.0000000000000551
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发表时间：
2016-09
期刊：
影响因子：
3
通讯作者：
Keating NL
中科院分区：
文献类型：
--
作者：
Pace LE;Dusetzina SB;Keating NL
《平价医疗法案》（ACA）要求，从2013年1月起，大多数私人保险计划必须涵盖避孕服务，而不需要患者分担费用。ACA的授权是否影响了长效可逆避孕药（LARC）的使用还不得而知。这篇文章的目的是评估LARC成本分担和吸收的趋势之前和一年后，ACA的避孕任务的实施。回顾性队列研究使用Truven Health MarketScan 2010年1月至2013年12月的索赔数据。在2010-2013年期间，18-45岁的持续保险覆盖的口服避孕药、贴片、避孕环、注射剂或LARC索赔的妇女（N=3,794,793）。描述性统计用于评估2010年至2013年LARC成本分担和吸收的趋势。中断时间序列模型用于评估时间、ACA和ACA后时间对LARC成本分担和启动率的关系，并根据患者和计划特征进行调整。对宫内节育器和植入物零费用分担的索赔比例分别从2010年的36.6%和9.3%上升到2013年的87.6%和80.5%。ACA与这些比例及其增长率的显著增加有关（水平和斜率变化均P< 0.001）。随着时间的推移，2013年1月aca实施后LARC使用水平没有显著变化（P=0.44）， aca实施后LARC使用水平的增长速度略低于之前（趋势贝塔系数：- 0.004,P <0.001）。ACA显著降低了LARC的费用分摊，但在第一年还没有提高LARC的启动率。
The Affordable Care Act (ACA) required most private insurance plans to cover contraceptive services without patient cost-sharing as of January 2013 for most plans. Whether the ACA’s mandate has impacted long-acting reversible contraceptives (LARC) use is unknown. The aim of this article is to assess trends in LARC cost-sharing and uptake before and one year after implementation of the ACA’s contraceptive mandate. Retrospective cohort study using Truven Health MarketScan claims data from January 2010–December 2013. Women aged 18–45 with continuous insurance coverage with claims for oral contraceptive pills, patches, rings, injections, or LARC during 2010–2013 (N=3,794,793). Descriptive statistics were used to assess trends in LARC cost-sharing and uptake from 2010 through 2013. Interrupted time series models were used to assess the association of time, ACA, and time following the ACA on LARC cost-sharing and initiation rates, adjusting for patient and plan characteristics. The proportion of claims with $0 cost-sharing for IUDs and implants, respectively, rose from 36.6% and 9.3% in 2010, to 87.6% and 80.5% in 2013. The ACA was associated with a significant increase in these proportions and in their rate of increase (level and slope change both P<.001). LARC uptake increased over time with no significant change in level of LARC use post-ACA implementation in January 2013 (P=0.44) and a slightly slower rate of growth post-ACA than previously (beta coefficient for trend: −0.004, p<0.001). The ACA has significantly decreased LARC cost-sharing, but during its first year had not yet increased LARC initiation rates.