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Health Serv Res. 2016 Feb;51(1):187-204. doi: 10.1111/1475-6773.12326. Epub 2015 Jun 29.

The Association between High-Deductible Health Plan Transition and Contraception and Birth Rates.

Author information

1
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
2
Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN.
3
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.

Abstract

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.

KEYWORDS:

High-deductible; childbirth; contraception; managed care

PMID:
26118959
PMCID:
PMC4722206
DOI:
10.1111/1475-6773.12326
[Indexed for MEDLINE]
Free PMC Article

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