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: 10640979
• 负责人: CYNTHIA H CHUANG
• 金额: $ 31.11万
• 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 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10640979
• 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 这个项目试图了解州和联邦政策如何要求健康保险公司承保处方 避孕措施对中期和长期公共卫生结果都产生了影响。中间结果 包括在避孕和避孕使用方面的自付支出；长期成果包括 妊娠间隔和不良妊娠结局。这项研究很重要，因为联邦政府和 近年来，州一级的政策制定已经解决了避孕覆盖率问题，但避孕覆盖率 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，《患者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FDA批准的所有避孕方法提供免费保险，这是一项好处 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医疗计划 提供一定程度的避孕覆盖；在ACA之后，其中11个州要求免费 避孕覆盖率。在过去的20年里，33个州获得了扩大家庭资格的豁免 医疗补助计划下的规划服务。最后，ACA还允许扩大医疗补助计划，这一直是 迄今已在34个州和哥伦比亚特区实施，从而增加了低收入妇女的人数 免费的避孕措施。我们建议研究这些避孕政策的影响 使用差异中的差异分析，该分析将通过以下方式检查人口随时间的关键结果 比较那些暴露于保险政策和未暴露于保险政策的人。我们将使用MarketScan®商业广告 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 每年私人参保的个人和医疗补助数据，以确定如何实施州和 联邦避孕政策的影响：1)自掏腰包购买避孕药具；2)使用特定的 避孕方法和方法依从性；3)解释间隔、早产和低水平 出生体重。这项研究将提供必要的数据，为州和联邦两级制定政策提供参考 避孕覆盖政策对关键公共卫生结果的影响。它将先前的研究扩展到 研究的人口范围、研究的政策范围和调查的结果。调查结果将 说明避孕政策是实现千年发展目标的有效工具的程度 健康人们计划生育的目标是改善怀孕计划和间隔时间，防止意外 怀孕了。