Denial of tubal ligation in religious hospitals: Consumer attitudes when insurance limits hospital choice

Schueler, Kellie; Hebert, Luciana E.; Wingo, Erin; Freedman, Lori; Stulberg, Debra

doi:10.1016/j.contraception.2021.02.011

Cited by 6 publications

(8 citation statements)

References 22 publications

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“…In order to improve the knowledge among the care providers, a group discussion about the importance of PPTL, government incentives and criteria of PPTL was implemented in the second PDSA cycle. Few previous studies have highlighted the religious and cultural barriers to postpartum sterilization [ 15 , 16 ]. We could not stress this aspect in the present QI initiative.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Quality Improvement Initiative to Address the Barriers to Postpartum Tubal Ligation Among Multiparous Women

Sarkar¹,

Panneer²,

Vanya³

et al. 2022

Cureus

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Background: Unmet need for postpartum tubal ligation (PPTL) is still high in low-middle income countries. The commonly observed barriers are issues with the consent forms, non-availability of operation theater, lack of knowledge, patient desire for more children, partner opposition and social non-acceptance. Considering the unmet need and the barriers, this quality improvement (QI) initiative was conducted to increase the frequency of PPTL among multiparous women by 50% from baseline.Materials and methods: This QI was conducted at a tertiary care teaching hospital over a period of 18 months. The study consisted of three phases. Baseline observations during the pre-intervention phase over six months, intervention phase consisting of three Plan-Do-Study-Act (PDSA) cycles over 12 months and post-intervention surveillance phase over a period of three months. In the first PDSA cycle, hospital and provider barriers were focused on. The patient barrier was addressed in the second cycle. The barrier at the level of partner and family members was addressed in the third cycle.Results: The baseline prevalence of PPTL in the studied population over a period of six months was 30.2%. After the first PDSA cycle, the prevalence of PPTL performed increased from 30.2% to 49.5%. The prevalence increased to 68.8% after the second cycle. A further increase to 74.4% was observed after the third intervention. There was a satisfactory continuation rate of 72% at the end of the post-intervention followup phase conducted over four months.Conclusion: This QI initiative proved effective and sustainable over time. There was continuous motivation among the service providers to educate and counsel women for PPTL. Ultimately, we were able to address the low prevalence of PPTL through minor modifications in our hospital strategies.

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Section: Discussionmentioning

confidence: 99%

A Prospective Quality Improvement Initiative to Address the Barriers to Postpartum Tubal Ligation Among Multiparous Women

Sarkar¹,

Panneer²,

Vanya³

et al. 2022

Cureus

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“…In addition to the AmeriSpeak sample, this study sampled from Dynata, a non-probability-based sample drawn from panels, web intercept samples and specialty lists recruited via web and email invitations. A full description of this study’s methods is described elsewhere ( Schueler et al, 2021 ).…”

Section: Methodsmentioning

confidence: 99%

Reproductive healthcare denials among a privately insured population

Hebert

Wingo

Hasselbacher

et al. 2021

Preventive Medicine Reports

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This study aimed to quantify and examine reproductive healthcare denials experienced by individuals receiving employer-sponsored health insurance. We conducted a national cross-sectional survey using probability and non-probability-based panels from December 2019-January 2020. Eligible respondents were adults employed by any Standard and Poor’s 500 company, who received employer-sponsored health insurance. Respondents (n = 1,001) reported whether anyone on their healthcare plan had been denied a reproductive healthcare service in the past five years and details about their denials. We conducted bivariate analyses and multiple logistic regression to estimate factors associated with denials. Eleven percent of respondents (14% of women; 10% of men) reported a denial. Compared to lower-income respondents, those with income ≥ $50,000/year were less likely to experience a denial (aOR = 0.53; 95% CI 0.29–0.97). Compared to respondents who were never married, being married (aOR = 2.33; 95% CI: 1.03–5.30) or cohabiting (aOR = 2.43; 95% CI: 1.03–5.72) significantly increased odds of experiencing a denial. In 38% of cases the patient learned of the denial at a scheduled visit, while 23% learned in an emergency setting, and 13% after the encounter. Individuals covered by employer-sponsored health insurance continue to be denied coverage of preventive services. Employers and insurers can facilitate access to reproductive healthcare by ensuring that their plans include comprehensive coverage and in-network providers offer comprehensive services.

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“…Findings from our national survey also demonstrate employee expectations around employer responsibility. When presented with the example of a woman being denied access to a tubal ligation immediately following a cesarean-section birth because the delivery occurred in a Catholic hospital and the woman had no other hospital choice, the majority of respondents (60%) felt that something should have been done differently [18] . Within this group, 33% thought the employer should have done something differently.…”

Section: Why Do Employers Not Do More To Ensure Employee Access To Re...mentioning

confidence: 99%

“…Within this group, 33% thought the employer should have done something differently. In addition, 79% of all respondents felt that the employer should do something to assist the couple, with 44% believing the employer should ask the insurance company to add a new hospital to the network, 38% thought the employer should ask the insurance company to cover the costs, and 24% thought the employer should cover the extra costs [18] .…”

Section: Why Do Employers Not Do More To Ensure Employee Access To Re...mentioning

confidence: 99%

“…Interviewees described each of these roles as follows: benefits managers oversee insurance and other employee benefits, consultants advise companies on employee benefits, and brokers can serve as third parties who help companies assemble and purchase insurance products to offer employees. Findings from these interviews also informed the development of a nationally representative, cross-sectional survey of employees at Standard and Poor's (S&P) 500 companies who receive health insurance through their employer [ 13 , 18 ]. We conducted interviews between January and May 2019 by trained researchers and recorded for transcription, allowing for qualitative data analysis of thematic content [19] .…”

Section: Introductionmentioning

confidence: 99%

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Beyond Hobby Lobby: Employer's responsibilities and opportunities to improve network access to reproductive healthcare for employees

et al. 2022

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Denial of tubal ligation in religious hospitals: Consumer attitudes when insurance limits hospital choice

Cited by 6 publications

References 22 publications

A Prospective Quality Improvement Initiative to Address the Barriers to Postpartum Tubal Ligation Among Multiparous Women

A Prospective Quality Improvement Initiative to Address the Barriers to Postpartum Tubal Ligation Among Multiparous Women

Reproductive healthcare denials among a privately insured population

Beyond Hobby Lobby: Employer's responsibilities and opportunities to improve network access to reproductive healthcare for employees

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