Impact of State and Federal Contraceptive Coverage Policies on Contraceptive Use, Costs, and Pregnancy Outcomes

州和联邦避孕覆盖政策对避孕药具使用、成本和妊娠结果的影响

• 批准号: 10436204
• 负责人: CYNTHIA H CHUANG
• 金额: $ 31.07万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10436204
• 关键词: Impact; State; Federal; Contraceptive; Coverage

Abstract This project seeks to understand how state and federal policies requiring health insurers to cover prescription contraceptives have impacted both intermediate and long-term public health outcomes. Intermediate outcomes include out-of-pocket spending on contraception and contraceptive use; long-term outcomes include pregnancy spacing and adverse pregnancy outcomes. This research is important because both federal and state-level policymaking have addressed contraceptive coverage in recent years, yet contraceptive coverage policies continue to be challenged and the lack of information about policy impact hampers efforts to address the long-term public health policy goal of reducing unintended pregnancies and their consequences. At the federal level, the Patient Protection and Affordable Care Act (ACA) required most private health plans to provide no-cost coverage for all FDA-approved contraceptive methods beginning in August 2012, a benefit already provided to publicly-insured women. Prior to the ACA, 28 states and D.C. required health plans to provide some degree of contraceptive coverage; following the ACA, 11 of those states required no-cost contraceptive coverage. Over the past 20 years, 33 states have obtained waivers to expand eligibility for family planning services under Medicaid. Finally, the ACA also allowed for Medicaid expansion, which has been implemented in 34 states and D.C. to date, thereby increasing the number of low-income women with access to no-cost contraceptive coverage. We propose studying the impact of these contraceptive coverage policies using a difference-in-differences analyses, which will examine key outcomes for populations over time by comparing those exposed and not exposed to coverage policies. We will use the MarketScan® Commercial Claims and Encounters database which includes health care utilization information on approximately 50 million privately insured individuals per year and Medicaid data to determine how the implementation of state and federal contraceptive coverage policies impact: 1) out-of-pocket spending for contraceptives; 2) use of specific contraceptive methods and method adherence; and 3) interpregnancy intervals, preterm birth, and low birthweight. This study will provide needed data to inform policymaking at the state and federal levels on the impact of contraceptive coverage policies on key public health outcomes. It expands prior research in the scope of the population studied, the range of policies studied, and the outcomes investigated. Findings will indicate the extent to which contraceptive coverage policies are an effective tool for achieving the HealthyPeople family planning goals of improving pregnancy planning and spacing, and preventing unintended pregnancy.

摘要 本项目旨在了解州和联邦政策如何要求健康保险公司支付处方药 避孕药具对中期和长期的公共卫生结果都产生了影响。中间成果 包括在避孕和使用避孕药具方面自付费用;长期结果包括 妊娠间隔和不良妊娠结局。这项研究很重要，因为联邦和 近年来，国家一级的决策已经解决了避孕覆盖率问题， 政策继续受到挑战，缺乏关于政策影响的信息阻碍了解决 减少意外怀孕及其后果的长期公共卫生政策目标。 在联邦一级，《病人保护和平价医疗法案》（ACA）要求大多数私人医疗计划， 从2012年8月开始，为所有FDA批准的避孕方法提供免费保险， 已经提供给有公共保险的妇女。在ACA之前，28个州和华盛顿特区要求健康计划， 提供一定程度的避孕覆盖;在ACA之后，其中11个州要求免费 避孕普及率。在过去的20年里，33个州已经获得豁免，以扩大家庭的资格， 医疗补助计划下的服务。最后，ACA还允许医疗补助扩大，这已经成为 到目前为止，该计划已在34个州和华盛顿特区实施，从而增加了低收入妇女的人数， 到免费避孕保险。我们建议研究这些避孕覆盖政策的影响 使用差异中的差异分析，该分析将通过以下方式检查人群随时间推移的关键结果： 比较那些暴露和不暴露于覆盖政策的人。我们将使用MarketScan®商业 索赔和遭遇数据库，其中包括约5000万人的医疗保健利用信息 私人保险个人每年和医疗补助数据，以确定如何实施国家和 联邦避孕覆盖政策的影响：1）避孕药具的自付支出; 2）使用特定的 避孕方法和方法依从性;和3）解释间隔，早产，低 出生体重这项研究将提供必要的数据，为州和联邦各级的政策制定提供信息， 避孕普及政策对主要公共卫生成果的影响。它扩展了先前的研究， 所研究的人口范围、所研究的政策范围以及所调查的结果。发现将 说明避孕普及政策在多大程度上是实现 计划生育的目标是改善怀孕计划和间隔， 怀孕