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Association of Availability of State Medicaid Coverage for Abortion With Abortion Access in the United States. Obstet Gynecol 2022; 140:623-630. [PMID: 36075060 DOI: 10.1097/aog.0000000000004933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/30/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate the association between state Medicaid coverage for abortion and abortion access measures among U.S. patients. METHODS We analyzed data from the Guttmacher Institute's 2014 Abortion Patient Survey. Respondents were included if they reported being enrolled in Medicaid, regardless of whether Medicaid covered the abortion. The exposure was self-report of residence in a state where Medicaid can be used to pay for abortion. Access outcomes included more than 14 days' wait time between decision for abortion and abortion appointment, presentation at more than 10 weeks of gestation when in the first trimester, and travel time more than 60 minutes to the clinic. Multivariable regression was performed to test the association between state Medicaid abortion coverage and dichotomous access outcomes, controlling for patient demographics. RESULTS Of 2,579 respondents enrolled in Medicaid who reported state of residence, 1,694 resided in states with Medicaid coverage for abortion and 884 resided in states without Medicaid coverage for abortion. Patients residing in states with Medicaid coverage for abortion had lower odds and rates of waiting more than 14 days between deciding to have an abortion and the appointment (adjusted odds ratio [aOR] 0.70; 95% CI 0.57-0.85, 66.8% vs 74.1%, P <.001), having abortions at more than 10 weeks of gestation when in the first trimester (aOR 0.62; 95% CI 0.49-0.80, 13.6% vs 20.1%, P <.001), and traveling more than 60 minutes to the abortion clinic (aOR 0.63; 95% CI 0.51-0.78, 18.7% vs 27.6%, P <.001) when compared with patients residing in states without Medicaid coverage for abortion. CONCLUSION Availability of state Medicaid coverage for abortion is associated with increased abortion access. Our findings support repealing the Hyde Amendment to promote equitable access to reproductive health care, particularly in the post-Roe era.
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Upadhyay UD, Weitz TA, Jones RK, Barar RE, Foster DG. Denial of Abortion Because of Provider Gestational Age Limits in the United States. Am J Public Health 2022; 112:1305-1312. [PMID: 35969817 PMCID: PMC9382160 DOI: 10.2105/ajph.2013.301378r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Soleimani Movahed M, Husseini Barghazan S, Askari F, Arab Zozani M. The Economic Burden of Abortion and Its Complication Treatment Cares: A Systematic Review. J Family Reprod Health 2021; 14:60-67. [PMID: 33603795 PMCID: PMC7865195 DOI: 10.18502/jfrh.v14i2.4354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: Abortion related procedures contribute to a significant economic burden because it resulted in prolonged hospital stays for patients. We aimed to gather available evidence on the economic burden of abortion and post-abortion complication treatment cares worldwide. Materials and methods: PubMed, Web of Science, Scopus, and Embase databases were searched through November 2019. Two researchers independently conducted the quality assessment and data extraction process. The latest web-based tool adjusted the estimates of costs expressed in one specific currency and price year into a specific target currency (the year 2016 $US). Results: Totally, 2082 records were retrieved and 32 studies were deemed eligible for qualitative synthesis. The mean total costs per patient with abortion or post-abortion care ranged from $23 to $564. The annual costs ranged from 189,000 $US to 134 million $US. Conclusion: Abortion and post-abortion care impose a substantial economic burden on society. Understanding the burdensome of abortion or pregnancy termination among policymakers provides vital information and enables informed decisions to be made to establish health care priorities and allocating scarce resources.
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Affiliation(s)
- Maryam Soleimani Movahed
- Department of Health Economics, School of Health Management and Information Science, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Husseini Barghazan
- Department of Health Economics, School of Health Management and Information Science, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Askari
- Student Research Committee, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Morteza Arab Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
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Leslie DL, Liu G, Jones BS, Roberts SCM. Healthcare costs for abortions performed in ambulatory surgery centers vs office-based settings. Am J Obstet Gynecol 2020; 222:348.e1-348.e9. [PMID: 31629727 DOI: 10.1016/j.ajog.2019.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/06/2019] [Accepted: 10/12/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several states require that abortions be provided in ambulatory surgery centers. Supporters of such laws argue that they make abortions safer, yet previous studies have found no differences in abortion-related morbidities or adverse events for abortions performed in ambulatory surgery centers versus office-based settings. However, little is known about how costs of abortions provided in ambulatory surgery centers differ from those provided in office-based settings. OBJECTIVE To compare healthcare expenditures for abortions performed in ambulatory surgery centers versus office-based settings using a large national private insurance claims database. MATERIALS AND METHODS A retrospective cohort study compared expenditures for abortions performed in ambulatory surgery centers versus office-based settings. Data on women who had abortions in an ambulatory surgery center or office-based setting between January 1, 2011, and December 31, 2014 were obtained from the MarketScan Commercial Claims and Encounters database. The sample was limited to women who were continuously enrolled in their insurance plans for at least 1 year before and at least 6 weeks after the abortion. Healthcare expenditures were assessed separately for the index abortion and the 6-week period after the abortion. Costs were measured from the perspective of the healthcare system and included all payments to the provider, including insurance company payments and any patient out-of-pocket payments. RESULTS Overall, 49,287 beneficiaries who had 50,311 abortions met inclusion criteria. Of the included abortions, 47% were first-trimester aspiration, 27% first-trimester medication, and 26% second-trimester or later abortions. Most abortions (89%) were provided in office-based settings, with 11% provided in ambulatory surgery centers. Unadjusted mean index abortion costs were higher in ambulatory surgery centers than in office-based settings ($1704 versus $810; P < .001). After adjusting for patient clinical and demographic characteristics, costs of index abortions were $772 higher (95% confidence interval, $746-$797), total follow-up costs for abortions that had any follow-up care were $1099 higher (95% confidence interval, $1004-$1,195), and total follow-up costs for abortions that had an abortion-related morbidity or adverse event were not significantly different in ambulatory surgery centers compared to office-based settings. There were also no significant differences in the likelihood of having any follow-up care or abortion-related event follow-up care. CONCLUSION Abortions performed at ambulatory surgery centers are significantly more costly than those performed in office-based settings, with no difference in the likelihood of receiving follow-up care. Laws requiring that abortions be provided in ambulatory surgery centers may only result in increased costs for abortions, with no effect on abortion safety.
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Affiliation(s)
- Douglas L Leslie
- Center for Applied Studies in Health Economics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA.
| | - Guodong Liu
- Center for Applied Studies in Health Economics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Bonnie Scott Jones
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
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Barr-Walker J, Jayaweera RT, Ramirez AM, Gerdts C. Experiences of women who travel for abortion: A mixed methods systematic review. PLoS One 2019; 14:e0209991. [PMID: 30964860 PMCID: PMC6456165 DOI: 10.1371/journal.pone.0209991] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 12/16/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To systematically review the literature on women's experiences traveling for abortion and assess how this concept has been explored and operationalized, with a focus on travel distance, cost, delays, and other barriers to receiving services. BACKGROUND Increasing limitations on abortion providers and access to care have increased the necessity of travel for abortion services around the world. No systematic examination of women's experiences traveling for abortion has been conducted; this mixed-methods review provides a summary of the qualitative and quantitative literature on this topic. METHODS A systematic search was conducted using PubMed, Embase, Web of Science, Popline, and Google Scholar in July 2016 and updated in March 2017 (PROSPERO registration # CRD42016046007). We included original research studies that described women's experiences traveling for abortion. Two reviewers independently performed article screening, data extraction and determination of final inclusion for analysis. Critical appraisal was conducted using CASP, STROBE, and MMAT checklists. RESULTS We included 59 publications: 46 quantitative studies, 12 qualitative studies, and 1 mixed-methods study. Most studies were published in the last five years, relied on data from the US, and discussed travel as a secondary outcome of interest. In quantitative studies, travel was primarily conceptualized and measured as road or straight-line distance to abortion provider, though some studies also incorporated measures of burdens related to travel, such as financial cost, childcare needs, and unwanted disclosure of their abortion status to others. Qualitative studies explored regional disparities in access to abortion care, with a focus on the burdens related to travel, the impact of travel on abortion method choice, and women's reasons for travel. Studies generally were of high quality, though many studies lacked information on participant recruitment or consideration of potential biases. CONCLUSIONS Standardized measurements of travel, including burdens associated with travel and more nuanced considerations of travel costs, should be implemented in order to facilitate comparison across studies. More research is needed to explore and accurately capture different dimensions of the burden of travel for abortion services on women's lives.
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Affiliation(s)
- Jill Barr-Walker
- ZSFG Library, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Ruvani T. Jayaweera
- Ibis Reproductive Health, Oakland, California, United States of America
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Ana Maria Ramirez
- Ibis Reproductive Health, Oakland, California, United States of America
| | - Caitlin Gerdts
- Ibis Reproductive Health, Oakland, California, United States of America
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Kimport K, Rowland B. Taking Insurance in Abortion Care: Policy, Practices, and the Role of Poverty. RESEARCH IN THE SOCIOLOGY OF HEALTH CARE 2017. [DOI: 10.1108/s0275-495920170000035003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Jerman J, Jones RK. Secondary measures of access to abortion services in the United States, 2011 and 2012: gestational age limits, cost, and harassment. Womens Health Issues 2014; 24:e419-24. [PMID: 24981401 PMCID: PMC4946165 DOI: 10.1016/j.whi.2014.05.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 05/07/2014] [Accepted: 05/09/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Aspects of U.S. clinical abortion service provision such as gestational age limits, charges for abortion services, and anti-abortion harassment can impact the accessibility of abortion; this study documents changes in these measures between 2008 and 2012. METHODS In 2012 and 2013, we surveyed all known abortion-providing facilities in the United States (n = 1,720). This study summarizes information obtained about gestational age limits, charges, and exposure to anti-abortion harassment among clinics; response rates for relevant items ranged from 54% (gestational limits) to 80% (exposure to harassment). Weights were constructed to compensate for nonresponding facilities. We also examine the distribution of abortions and abortion facilities by region. FINDINGS Almost all abortion facilities (95%) offered abortions at 8 weeks' gestation; 72% did so at 12 weeks, 34% at 20 weeks, and 16% at 24 weeks in 2012. In 2011 and 2012, the median charge for a surgical abortion at 10 weeks gestation was $495, and $500 for an early medication abortion, compared with $503 and $524 (adjusted for inflation) in 2009. In 2011, 84% of clinics experienced at least one form of harassment, only slightly higher than found in 2009. Hospitals and physicians' offices accounted for a substantially smaller proportion of facilities in the Midwest and South. Clinics in the Midwest and South were exposed to more harassment than their counterparts in the Northeast and West. CONCLUSIONS Although there was a substantial decline in abortion incidence between 2008 and 2011, the secondary measures of abortion access examined in this study changed little during this time period.
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Out-of-Pocket Costs and Insurance Coverage for Abortion in the United States. Womens Health Issues 2014; 24:e211-8. [DOI: 10.1016/j.whi.2014.01.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 01/17/2014] [Accepted: 01/20/2014] [Indexed: 11/17/2022]
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Upadhyay UD, Weitz TA, Jones RK, Barar RE, Foster DG. Denial of abortion because of provider gestational age limits in the United States. Am J Public Health 2013; 104:1687-94. [PMID: 23948000 DOI: 10.2105/ajph.2013.301378] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the factors influencing delay in seeking abortion and the outcomes for women denied abortion care because of gestational age limits at abortion facilities. METHODS We compared women who presented for abortion care who were under the facilities' gestational age limits and received an abortion (n = 452) with those who were just over the gestational age limits and were denied an abortion (n = 231) at 30 US facilities. We described reasons for delay in seeking services. We examined the determinants of obtaining an abortion elsewhere after being denied one because of facility gestational age limits. We then estimated the national incidence of being denied an abortion because of facility gestational age limits. RESULTS Adolescents and women who did not recognize their pregnancies early were most likely to delay seeking care. The most common reason for delay was having to raise money for travel and procedure costs. We estimated that each year more than 4000 US women are denied an abortion because of facility gestational limits and must carry unwanted pregnancies to term. CONCLUSIONS Many state laws restrict abortions based on gestational age, and new laws are lowering limits further. The incidence of being denied abortion will likely increase, disproportionately affecting young and poor women.
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Affiliation(s)
- Ushma D Upadhyay
- Ushma D. Upadhyay, Tracy A. Weitz, Rana E. Barar, and Diana Greene Foster are with Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, and the Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco. Rachel K. Jones is with the Guttmacher Institute, New York, NY
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Jones RK, Upadhyay UD, Weitz TA. At What Cost? Payment for Abortion Care by U.S. Women. Womens Health Issues 2013; 23:e173-8. [DOI: 10.1016/j.whi.2013.03.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/28/2013] [Accepted: 03/04/2013] [Indexed: 11/27/2022]
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Jones RK, Finer LB. Who has second-trimester abortions in the United States? Contraception 2012; 85:544-51. [PMID: 22176796 DOI: 10.1016/j.contraception.2011.10.012] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 10/21/2011] [Accepted: 10/21/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Little is known about the characteristics of second-trimester abortion patients. STUDY DESIGN Data come from a national sample of 9493 women obtaining abortions in 2008. Chi-square statistics and logistic regression were used to examine demographic characteristics of women having abortions at 13 or more weeks since last menstrual period (LMP) and women having abortions at 13-15 weeks LMP compared to 16+ weeks LMP. RESULTS In 2008, 10.3% of abortions in the United States were 13 weeks LMP or later, including 4.0% at 16+ weeks. Groups most likely to have abortions at 13 weeks or later included black women, women with less education, those using health insurance to pay for the procedure and those who had experienced three or more disruptive events in the last year. Groups more likely to have an abortion at 16 weeks or later included black women, higher income women and those paying with health insurance. CONCLUSIONS Black women and those with less education would most benefit from increased availability of first-trimester abortion services.
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Winikoff B, Hassoun D, Bracken H. Introduction and provision of medical abortion: a tale of two countries in which technology is necessary but not sufficient. Contraception 2011; 83:322-9. [DOI: 10.1016/j.contraception.2010.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 08/10/2010] [Accepted: 08/17/2010] [Indexed: 11/15/2022]
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Cockrill K, Weitz TA. Abortion Patients' Perceptions of Abortion Regulation. Womens Health Issues 2010; 20:12-9. [DOI: 10.1016/j.whi.2009.08.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 08/12/2009] [Accepted: 08/12/2009] [Indexed: 10/20/2022]
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Jones BS, Weitz TA. Legal barriers to second-trimester abortion provision and public health consequences. Am J Public Health 2009; 99:623-30. [PMID: 19197087 PMCID: PMC2661467 DOI: 10.2105/ajph.2007.127530] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2008] [Indexed: 11/04/2022]
Abstract
Many women need access to abortion care in the second trimester. Most of this care is provided by a small number of specialty clinics, which are increasingly targeted by regulations including bans on so-called partial birth abortion and requirements that the clinic qualify as an ambulatory surgical center. These regulations cause physicians to change their clinical practices or reduce the maximum gestational age at which they perform abortions to avoid legal risks. Ambulatory surgical center requirements significantly increase abortion costs and reduce the availability of abortion services despite the lack of any evidence that using those facilities positively affects health outcomes. Both types of laws threaten to further reduce access to and quality of second-trimester abortion care.
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Insured Women and Payment for Elective Abortion. Womens Health Issues 2008; 18:347-50. [DOI: 10.1016/j.whi.2008.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 03/14/2008] [Accepted: 03/16/2008] [Indexed: 11/18/2022]
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