Abstract
Access to reproductive health services is a public health goal. It is unknown how geographic and health plan network availability of Catholic and non-Catholic hospitals may be associated with access to reproductive health services in the United States. To characterize the market share of Catholic hospitals in the United States, both overall and within Marketplace health insurance plans' hospital networks. This cross-sectional study of US counties used data on hospitals' Catholic affiliation and discharges, hospital networks in Marketplace health insurance plans, and US Census population data to construct a national, county-level data set. The Catholic hospital market share overall in each county and in Marketplace plans' hospital networks in each county were calculated. The study examined whether the Catholic hospital market share was different within Marketplace networks compared with the counties they served. Data analysis was conducted in May and June 2018. The overall Catholic hospital market share was calculated on the basis of the share of discharges in Catholic hospitals in a county compared with all hospital discharges. Overall market share was categorized as minimal (≤2%), low (>2% to ≤20%), high (>20% to ≤70%), or dominant (>70%). The Catholic hospital market share in Marketplace networks was calculated as the share of Catholic hospital discharges in each Marketplace network. The sample included 4450 hospitals in 3101 counties. Overall, 26.1% of US counties had minimal Catholic hospital market share, 38.6% had low Catholic hospital market share, and 35.3% had high or dominant Catholic hospital market share; 38.7% of US reproductive-aged women resided in counties with high or dominant Catholic hospital market share. Among counties with Catholic hospital market share greater than 2%, the distribution of the median Marketplace network's Catholic hospital market share (median [interquartile range], 4.6% [0%-24.3%]) was lower than overall Catholic hospital market share (median [interquartile range], 18.5% [8.1%-36.5%]). The median Marketplace hospital network had a lower Catholic hospital market share than the county overall in 68.0% of US counties with Catholic hospital market share greater than 2%. In this national study, 35.3% of counties had high or dominant Catholic hospital market share serving an estimated 38.7% of US women of reproductive age. Marketplace health insurance plans' hospital networks included a lower share of Catholic hospitals than the counties they serve.
Highlights
Access to safe and effective reproductive health services is widely recognized as a public health policy goal.[1]
Among counties with Catholic hospital market share greater than 2%, the distribution of the median Marketplace network’s Catholic hospital market share was lower than overall Catholic hospital market share
Counties are shown by their Catholic hospital market shares
Summary
Access to safe and effective reproductive health services is widely recognized as a public health policy goal.[1] The Patient Protection and Affordable Care Act contained several provisions to expand access to reproductive health services. These included expanding insurance coverage to an estimated 20 million people, requiring insurers to cover maternity care, and requiring insurers to cover the full range of US Food and Drug Administration–approved contraceptive methods without patient cost-sharing.[2,3,4] Rigorous empirical work suggests that these provisions have contributed to better access to contraceptive care and may have improved pregnancy-related outcomes.[5,6,7,8]. This study explores factors that may impede health system access
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