TY - JOUR
T1 - The association between high-deductible health plan transition and contraception and birth rates
AU - Graves, Amy J.
AU - Kozhimannil, Katy B.
AU - Kleinman, Ken P.
AU - Wharam, J. Frank
N1 - Publisher Copyright:
© Health Research and Educational Trust.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - 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.
AB - 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.
KW - High-deductible
KW - childbirth
KW - contraception
KW - managed care
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U2 - 10.1111/1475-6773.12326
DO - 10.1111/1475-6773.12326
M3 - Article
C2 - 26118959
AN - SCOPUS:84956817226
SN - 0017-9124
VL - 51
SP - 187
EP - 204
JO - Health services research
JF - Health services research
IS - 1
ER -