Abstract
ObjectiveUp to 50% of pregnancies are unintended in the United States, and the healthcare costs associated with pregnancy are the most expensive among hospitalized conditions. The current study aims to assess Medicaid spending on various methods of contraception and on pregnancy care including unintended pregnancies.MethodsWe analyzed Medicaid health claims data from 2004 to 2010. Women 14–49 years of age initiating contraceptive methods and pregnant women were included as separate cohorts. Medicaid spending was summarized using mean all-cause and contraceptive healthcare payments per patient per month (PPPM) over a follow-up period of up to 12 months. Medicaid payments were also estimated in 2008 per female member of childbearing age per month (PFCPM) and per member per month (PMPM). Medicaid payments on unintended pregnancies were also evaluated PFCPM and PMPM in 2008.ResultsFor short-acting reversible contraception (SARC) users, all-cause payments and contraceptive payments PPPM were respectively $365 and $18.3 for oral contraceptive (OC) users, $308 and $19.9 for transdermal users, $215 and $21.6 for vaginal ring users, and $410 and $8.8 for injectable users. For long-acting reversible contraception (LARC) users (follow-up of 9–10 months), corresponding payments were $194 and $36.8 for IUD users, and $237 and $29.9 for implant users. Pregnancy cohort all-cause mean healthcare payments PPPM were $610. Payments PFCPM and PMPM for contraceptives were $1.44 and $0.54, while corresponding costs of pregnancies were estimated at $39.91 and $14.81, respectively. Payments PFCPM and PMPM for contraceptives represented a small fraction at 6.56% ($1.44/$21.95) and 6.63% ($0.54/$8.15), respectively of the estimated payments for unintended pregnancy.ConclusionsThis study of a large sample of Medicaid beneficiaries demonstrated that, over a follow-up period of 12 months, Medicaid payments for pregnancy were considerably higher than payments for either SARC or LARC users. Healthcare payments for contraceptives represented a small proportion of payments for unintended pregnancy when considering the overall Medicaid population perspective in 2008.
Highlights
Healthcare costs associated with pregnancy and delivery, and with the care of newborn infants are significant; they represent the two most expensive conditions requiring hospitalization billed to Medicaid in the United States (US) [1]
Payments PFCPM and per member per month (PMPM) for contraceptives represented a small fraction at 6.56% ($1.44/$21.95) and 6.63% ($0.54/$8.15), respectively of the estimated payments for unintended pregnancy
This study of a large sample of Medicaid beneficiaries demonstrated that, over a follow-up period of 12 months, Medicaid payments for pregnancy were considerably higher than payments for either short-acting reversible contraception (SARC) or long-acting reversible contraceptive (LARC) users
Summary
Healthcare costs associated with pregnancy and delivery, and with the care of newborn infants are significant; they represent the two most expensive conditions requiring hospitalization billed to Medicaid in the US [1]. Studies on cost of contraceptive coverage relative to pregnancy and maternity care have consistently reported cost savings associated with contraceptive coverage [14,15,16] Adequate coverage and access to contraception are important issues for payers and employers to consider if they support the public health goal of reducing unintended pregnancies and their costs. In the recent Contraceptive CHOICE Project, a research study that supports the efficacy of long-acting reversible contraceptive (LARC) methods as a means of reducing unintended pregnancies, participants using oral contraceptive pills, a transdermal patch, or a vaginal ring had an adjusted risk of contraceptive failure that was 20 times as high as the risk among those using LARC [20]. The Contraceptive CHOICE Project reported that when provided with counseling and their choice of contraceptive method at no cost, 67% of eligible women chose an intrauterine device (IUD) or an implant, compared with less than 6% of women in the general population who chose these methods [21]
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