вторник, 11 декабря 2007 г.

insurance

ORIGINAL RESEARCH

Changes in Prescription Contraceptive Use, 1995–2002

The Effect of Insurance Status

Kelly R. Culwell, MD1 and Joe Feinglass, PhD2

From the 1Department of Obstetrics and Gynecology and 2Division of General Internal Medicine and Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

OBJECTIVE: To examine changes in prescription contraception use between 1995 and 2002 by insurance status among women at risk for unintended pregnancy.

METHODS: Data from the National Survey of Family Growth, including 4,767 women at risk of unintended pregnancy in 1995 and 3,569 in 2002, were used to evaluate changes in primary contraception methods by health insurance status and year of survey. Logistic regression models tested differences in the likelihood of prescription contraceptive use among privately insured, publicly insured, and uninsured women in each year, after controlling for age, race and ethnicity, education, income, employment, marital status, number of children, religion, and self reported overall health.

RESULTS: Overall prescription contraceptive use increased between 1995 and 2002 by 3% (48.9% to 51.9%, P=.049). Nonuse of contraception also increased (11.6% to 16.1%, P<.001). The change in the likelihood of prescription contraceptive use was greatest and only significant among privately insured women (+5.5%, P=.002). In multiple regression analysis, women in 1995 were 10% less likely to report use of prescription contraceptives compared with women in 2002 (relative risk 0.90, 95% confidence interval 0.82–0.98), and uninsured women were more than 20% less likely to report prescription contraceptive use compared with privately insured women (relative risk 0.78, 95% confidence interval 0.67–0.90).

CONCLUSION: Prescription contraceptive use increased most significantly among privately insured women between 1995 and 2002, potentially reflecting state mandates enacted during that period requiring contraceptive coverage by private insurers. It is important for clinicians to understand these differences and address issues of insurance coverage with patients when discussing contraceptive options.

LEVEL OF EVIDENCE: III

Obstetrics & Gynecology 2007;110:1371-1378
© 2007 by The American College of Obstetricians and Gynecologists

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