Payment for Contraceptive Services in Safety Net Clinics Roles of Affordable Care Act, Title X, and State Programs

被引:12
作者
Darney, Blair G. [1 ,2 ,3 ]
Biel, Frances M. [1 ]
Rodriguez, Maria I. [1 ]
Jacob, R. Lorie [4 ]
Cottrell, Erika K. [4 ]
DeVoe, Jennifer E. [5 ]
机构
[1] Oregon Hlth & Sci Univ, Dept Obstet & Gynecol, 3181 Southwest Sam Jackson Pk Rd,Mail Code L-466, Portland, OR 97239 USA
[2] Natl Inst Publ Hlth, Populat Res Ctr INSP CISP, Cuernavaca, Morelos, Mexico
[3] OHSU PSU Sch Publ Hlth, Portland, OR USA
[4] OCHIN Inc, Portland, OR USA
[5] Oregon Hlth & Sci Univ, Dept Family Med, Portland, OR 97201 USA
基金
美国医疗保健研究与质量局;
关键词
safety net; contraception; Title X; insurance; ACA; Medicaid expansion; FAMILY-PLANNING-SERVICES; COMMUNITY-HEALTH CENTERS; UNINTENDED PREGNANCY; INSURANCE-COVERAGE; UNITED-STATES; MEDICAID; ACCESS; POPULATION; IMPACT; DISPARITIES;
D O I
10.1097/MLR.0000000000001309
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objectives: We describe payor for contraceptive visits 2013-2014, before and after Medicaid expansion under the Affordable Care Act (ACA), in a large network of safety-net clinics. We estimate changes in the proportion of uninsured contraceptive visits and the independent associations of the ACA, Title X, and state family planning programs. Methods: Our sample included 237 safety net clinics in 11 states with a common electronic health record. We identified contraception-related visits among women aged 10-49 years using diagnosis and procedure codes. Our primary outcome was an indicator of an uninsured visit. We also assessed payor type (public/private). We included encounter, clinic, county, and state-level covariates. We used interrupted time series and logistic regression, and calculated multivariable absolute predicted probabilities. Results: We identified 162,666 contraceptive visits in 219 clinics. There was a significant decline in uninsured contraception-related visits in both Medicaid expansion and nonexpansion states, with a slightly greater decline in expansion states (difference-in-difference: -1.29 percentage points; confidence interval: -1.39 to -1.19). The gap in uninsured visits between expansion and nonexpansion states widened after ACA implementation (from 2.17 to 4.1 percentage points). The Title X program continues to fill gaps in insurance in Medicaid expansion states. Conclusions: Uninsured contraceptive visits at safety net clinics decreased following Medicaid expansion under the ACA in both expansion and nonexpansion states. Overall, levels of uninsured visits are lower in expansion states. Title X continues to play an important role in access to care and coverage. In addition to protecting insurance gains under the ACA, Title X and state programs should continue to be a focus of research and advocacy.
引用
收藏
页码:453 / 460
页数:8
相关论文
共 66 条
[1]   SOCIETAL AND INDIVIDUAL DETERMINANTS OF MEDICAL CARE UTILIZATION IN UNITED-STATES [J].
ANDERSEN, R ;
NEWMAN, JF .
MILBANK MEMORIAL FUND QUARTERLY-HEALTH AND SOCIETY, 1973, 51 (01) :95-124
[2]   REVISITING THE BEHAVIORAL-MODEL AND ACCESS TO MEDICAL-CARE - DOES IT MATTER [J].
ANDERSEN, RM .
JOURNAL OF HEALTH AND SOCIAL BEHAVIOR, 1995, 36 (01) :1-10
[3]   Uninsured Primary Care Visit Disparities Under the Affordable Care Act [J].
Angier, Heather ;
Hoopes, Megan ;
Marino, Miguel ;
Huguet, Nathalie ;
Jacobs, Elizabeth A. ;
Heintzman, John ;
Holderness, Heather ;
Hood, Carlyn M. ;
DeVoe, Jennifer E. .
ANNALS OF FAMILY MEDICINE, 2017, 15 (05) :434-442
[4]   An Early Look at Rates of Uninsured Safety Net Clinic Visits After the Affordable Care Act [J].
Angier, Heather ;
Hoopes, Megan ;
Gold, Rachel ;
Bailey, Steffani R. ;
Cottrell, Erika K. ;
Heintzman, John ;
Marino, Miguel ;
Devoe, Jennifer E. .
ANNALS OF FAMILY MEDICINE, 2015, 13 (01) :10-16
[5]  
[Anonymous], UN RAT WOM REPR AG H
[6]  
[Anonymous], 2020, LESBIAN GAY BISEXUAL
[7]  
[Anonymous], 2015, Status of state action on the Medicaid expansion decision
[8]  
[Anonymous], 2014, AM COMMUNITY SURVEY
[9]   Measuring Preventive Care Delivery Comparing Rates Across Three Data Sources [J].
Bailey, Steffani R. ;
Heintzman, John D. ;
Marino, Miguel ;
Hoopes, Megan J. ;
Hatch, Brigit A. ;
Gold, Rachel ;
Cowburn, Stuart C. ;
Nelson, Christine A. ;
Angier, Heather E. ;
DeVoe, Jennifer E. .
AMERICAN JOURNAL OF PREVENTIVE MEDICINE, 2016, 51 (05) :752-761
[10]   "Community vital signs": incorporating geocoded social determinants into electronic records to promote patient and population health [J].
Bazemore, Andrew W. ;
Cottrell, Erika K. ;
Gold, Rachel ;
Hughes, Lauren S. ;
Phillips, Robert L. ;
Angier, Heather ;
Burdick, Timothy E. ;
Carrozza, Mark A. ;
Devoe, Jennifer E. .
JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION, 2016, 23 (02) :407-412