Impact of no cost contraception on utilization and direct medical expenditures

 描述（由申请人提供）：截至2014年1月1日，患者保护和平价医疗法案（ACA）要求所有商业，雇主为基础的健康计划，除了某些宗教组织，涵盖避孕咨询和方法，而无需患者自付费用。在美国，大约三分之一的低收入妇女和58%的妇女参加了这类健康计划，这一规定可能对妇女的健康产生广泛的影响。许多专家乐观地认为，ACA的避孕任务将减少避孕使用模式的长期差异，从而减少意外怀孕率。然而，强制全面覆盖与避孕有关的服务和方法引起了相当大的争议，法律的挑战正在进行中，使《艾滋病法》的这一方面有可能被部分或全部推翻。更清楚地了解临床和 这项政策对妇女、付款人和卫生系统的经济影响，需要为平衡的讨论提供信息。通过使用ACA实施的自然实验来观察患者费用分摊，避孕方法使用模式，怀孕和直接医疗保健支出在任务实施期间的变化，我们拟议的工作将提供评估这项政策的价值所需的数据。我们的建议是创新的，在其框架周围的价值为基础的保险设计（VBID）的原则作为一种战略，以减少意外怀孕。根据VBID原则，卫生计划应实施鼓励提供循证服务的政策。在这种情况下，取消了ACA下避孕相关服务的费用分摊，使患者的经济激励与临床目标保持一致。我们建议在一个大的，全国性的妇女样本中研究ACA对妇女的影响，这些妇女参加了以雇主为基础的保险。这个样本提供了一个理想的数据源，以表征ACA对避孕药具使用，怀孕/出生率和支出的影响，并使我们能够检查其在健康计划内嵌套的不同收入类别之间和内部的影响。我们的工作将通过回答以下目标，提供关于ACA对避孕使用模式中有据可查的差异以及临床和经济结果的影响的最佳证据：1）确定取消病人费用分摊是否与避孕相关的门诊就诊的变化有关，2）确定取消患者费用分摊是否与避孕不使用和避孕方法填充模式（包括方法类型）的变化相关，使用和方法转换的一致性和3）检查费用分摊的取消是否与医疗支出相关的变化有关（即，门诊避孕、孕期护理、分娩和药物支出）。对于每一个目标，我们将审查费用分摊与我们的总体成果之间的关系，以及跨收入类别和收入类别内部的关系。

 DESCRIPTION (provided by applicant): As of January 1, 2014, the Patient Protection and Affordable Care Act (ACA) requires all commercial, employer-based health plans, except for certain religious organizations, to cover contraception counseling and methods without patient copayments. Because about one-third of low-income women and 58% of all women are enrolled in such health plans in the United States, this provision could have broad implications for women's health. Many experts are optimistic that the ACA contraceptive mandate will reduce long-standing disparities in contraception use patterns and subsequently, unintended pregnancy rates. However, mandated full coverage of contraception-related services and methods has generated considerable controversy, and legal challenges are on-going placing this aspect of the ACA at risk of being partially or fully overturned. A clearer understanding of the clinical and economic impact of this policy on women, payors and the health system is needed to inform a balanced discussion. By using the natural experiment of the ACA's implementation to observe changes in patient cost-sharing, contraceptive method use patterns, pregnancies, and direct health care spending during the mandate's implementation, our proposed work will provide the data needed to assess the value of this policy. Our proposal is innovative in its framing around value-based insurance design (VBID) principles as a strategy to decrease unintended pregnancy. Under VBID principles, health plans should implement policies that encourage the delivery of evidence-based services. In this instance, the elimination of cost-sharing under the ACA for contraceptive-related services aligns patient financial incentives with clinical goals. We proposed to study the impact of the ACA among women within a large, national sample of women enrolled in employer-based insurance. This sample provides an ideal data source to characterize the impact of the ACA on contraception use, pregnancy/birth rates and expenditures broadly, and allows us to examine its impact across and within different income categories nested within health plans. Our work will provide the best available evidence on the ACA's impact on well-documented disparities in contraception use patterns, as well as clinical and economic outcomes by answering the following aims: 1) to determine whether the elimination of patient cost-sharing is associated with changes in contraception-related office visits, 2) to determine whether the elimination of patient cost-sharing is associated with changes in contraception non-use and contraception method fill patterns, including method type, consistency of use and method switching and 3) to examine whether the elimination of cost-sharing is associated with changes related to medical spending (i.e., spending from outpatient contraceptive-visits, pregnancy care, births and drugs). For each aim, we will examine the relationship between cost-sharing and our outcomes overall as well as across and within income categories.