The association between high-deductible health plan transition and contraception and birth rates

Amy J. Graves, Katy B. Kozhimannil, Ken P. Kleinman, J. Frank Wharam

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objective To evaluate the association between employer-mandated enrollment into high-deductible health plans (HDHPs) and contraception and birth rates among reproductive-age women. Data Sources/Study Setting Using data from 2002 to 2008, we examined 1,559 women continuously enrolled in a Massachusetts health plan for 1 year before and after an employer-mandated switch from an HMO to a HDHP, compared with 2,793 matched women contemporaneously enrolled in an HMO. Study Design We used an individual-level interrupted time series with comparison series design to examine level and trend changes in clinician-provided contraceptives and a differences-in-differences design to assess annual birth rates. Data Collection/Extraction Methods Employer, plan, and member characteristics were obtained from enrollment files. Contraception and childbirth information were extracted from pharmacy and medical claims. Principal Findings Monthly contraception rates were 19.0-24.0 percent at baseline. Level and trend changes did not differ between groups (p =.92 and p =.36, respectively). Annual birth rates declined from 57.1/1,000 to 32.7/1,000 among HDHP members and from 61.9/1,000 to 56.2/1,000 among HMO controls, a 40 percent relative reduction in odds of childbirth (odds ratio = 0.60; p =.02). Conclusions Women who switched to HDHPs experienced a lower birth rate, which might reflect strategies to avoid childbirth-related out-of-pocket costs under HDHPs.

Original languageEnglish (US)
Pages (from-to)187-204
Number of pages18
JournalHealth services research
Issue number1
StatePublished - Feb 1 2016


  • High-deductible
  • childbirth
  • contraception
  • managed care

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