Are You Covered? Associations Between Patient Protection and Affordable Care Act Knowledge and Preventive Reproductive Service Use

Sawyer, Ashlee N.; Kwitowski, Melissa; Benotsch, Eric G.

doi:10.1177/0890117117736091

Cited by 3 publications

(3 citation statements)

References 39 publications

(78 reference statements)

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“…A 2016 survey of U.S. women aged 18-44 found that women were more likely to use preventive care when they had greater knowledge of covered services. 14 Addressing potential language and cultural barriers is important for engaging Hispanic/ Latina women and other groups. 31,44 While examining the interplay between race/ethnicity and health care use was not the focus of the current study, we found that Hispanic ethnicity was associated with lower rates of well-woman visits before pregnancy, lower odds of adequate prenatal care, and lower odds of six-week postpartum follow-up compared to Whites (Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…The ACA also mandated coverage for preventive care, including prenatal care. Among states that expanded Medicaid, some researchers have found higher use of preventive care 13,14 and increases in timely prenatal care 15 among insured women, while others found no early impact. 16 Evidence exists that women who have insurance in the preconception period are more likely to initiate prenatal care in the first trimester and have lower risk of adverse birth outcomes such as preterm births.…”

Section: Introductionmentioning

confidence: 99%

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Insurance Differences in Preventive Care Use and Adverse Birth Outcomes Among Pregnant Women in a Medicaid Nonexpansion State: A Retrospective Cohort Study

Taylor

Liu

Howell

2020

Journal of Women's Health

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Background: Lack of quality preventive care has been associated with poorer outcomes for pregnant women with low incomes. Health policy changes implemented with the Affordable Care Act (ACA) were designed to improve access to care. However, insurance coverage remains lower among women in Medicaid nonexpansion states. We compared health care use and adverse birth outcomes by insurance status among women giving birth in a large health system in a Medicaid nonexpansion state. Materials and Methods: We conducted a population-based retrospective cohort study using data for 9,613 women with deliveries during 2014-2015 at six hospitals associated with a large vertically integrated health care system in North Carolina. Adjusted logistic regression and zero-inflated negative binomial models examined associations between insurance status at delivery (commercial, Medicaid, or uninsured) and health care utilization (well-woman visits, late prenatal care, adequacy of prenatal care, postpartum follow-up, and emergency department [ED] visits) and outcomes (preterm birth, low birth weight, preeclampsia, and gestational diabetes). Results: Having Medicaid at delivery was associated with lower rates of well-woman visits (rate ratio [RR] 0.25, 95% CI 0.23-0.28), higher rates of ED visits (RR 2.93, 95% CI 2.64-3.25), and higher odds of late prenatal care (odds ratio [OR] 1.18, 95% CI 1.03-1.34) compared to having commercial insurance, with similar results for uninsured women. Differences in adverse pregnancy outcomes were not statistically significant after adjusting for patient characteristics. Conclusions: Findings suggest that large gaps exist in use of preventive care between Medicaid/uninsured and commercially insured women. Policymakers should consider ways to improve potential and realized access to care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Insurance Differences in Preventive Care Use and Adverse Birth Outcomes Among Pregnant Women in a Medicaid Nonexpansion State: A Retrospective Cohort Study

Taylor

Liu

Howell

2020

Journal of Women's Health

View full text Add to dashboard Cite

show abstract

“…Lack of knowledge about services is often considered a barrier to behavioral health service use [ 29 – 31 ]. Lack of knowledge about benefits is also known to act as a barrier to accessing other health services, such as preventive reproductive health services [ 32 ]. Adults with drug use disorders who have not sought treatment and do not know whether their plans cover drug use treatment may have a low level of treatment seeking intention [ 33 ] or be in the earliest “precontemplation” stage [ 34 ] of readiness to seek treatment.…”

Section: Discussionmentioning

confidence: 99%

Private health insurance coverage of drug use disorder treatment: 2005–2018

et al. 2020

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Many privately insured adults with drug use disorders in the United States do not have health care coverage for drug use treatment. The Affordable Care Act sought to redress this gap by including substance use treatments as essential health benefits under new plans offered. This study used data from 11,732 privately insured adult participants of the 2005-2018 National Survey on Drug Use and Health with drug use disorders to examine trends in drug use treatment coverage and the association of coverage with receiving treatment. 37.6% of the participants with drug use disorders did not know whether their plan covered drug use treatment, with little change over time. Among those who knew, coverage increased modestly between the 2005-2013 and 2014-2018 periods (73.5% vs. 77.5%, respectively, p = .015). Coverage was associated with receiving drug use treatment (adjusted odds ratio = 2.09, 95% confidence interval = 1.61-2.72, p < .001). However, even among participants with coverage, only 13.4% received treatment. Broader coverage of drug use treatment could potentially improve treatment rates.

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Association of Health Insurance Literacy with Health Care Utilization: a Systematic Review

et al. 2021

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Background Given increasing numbers of people experiencing transitions in health insurance due to declines in employer-sponsored insurance and changes in health policy, the understanding and application of health insurance terms and concepts (health insurance literacy) may be important for navigating use of health care. The study objective was to systematically review evidence on the relationship between health insurance literacy and health care utilization. Methods Medline, SCOPUS, Web of Science, CINAHL, PsychInfo, Cochrane Library, and reference lists of published literature were searched in August 2019. Quantitative, qualitative, and intervention studies that assessed the association of health insurance literacy as the exposure and health care utilization as the outcome were identified, without language or date restrictions. Outcomes were independently assessed by 2–3 reviewers. Results Twenty-one studies including a total of 62,416 subjects met inclusion criteria: three interventional trials, two mixed-methods studies, and sixteen cross-sectional studies. Ten of thirteen preventive care studies suggested that higher health insurance literacy was associated with greater utilization of primary care and other preventive services. Eight of nine studies of care avoidance demonstrated that individuals with lower health insurance literacy were more likely to delay or avoid care. A few studies had mixed results regarding the utilization of emergency department, inpatient, and surgical care. Discussion The emerging literature in this area suggests that health insurance literacy is an important factor that can enable effective utilization of health care, including primary care and preventive services. However, the literature is limited by a paucity of studies using validated tools that broadly measure health insurance literacy (rather than testing knowledge of specific covered services). Improving health insurance literacy of the general public and increasing plain language communication of health insurance plan features at the point of health care navigation may encourage more effective and cost-conscious utilization. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-06819-0.

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Are You Covered? Associations Between Patient Protection and Affordable Care Act Knowledge and Preventive Reproductive Service Use

Abstract: Current findings provide support for increasing resources for outreach and education of the general population about the provisions and benefits of health-care legislation, as well as personal health coverage plans.

Cited by 3 publications

References 39 publications

Insurance Differences in Preventive Care Use and Adverse Birth Outcomes Among Pregnant Women in a Medicaid Nonexpansion State: A Retrospective Cohort Study

Insurance Differences in Preventive Care Use and Adverse Birth Outcomes Among Pregnant Women in a Medicaid Nonexpansion State: A Retrospective Cohort Study

Private health insurance coverage of drug use disorder treatment: 2005–2018

Association of Health Insurance Literacy with Health Care Utilization: a Systematic Review

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