Preventive Services for Women Under the Affordable Care Act:

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

PURPOSE

Sexual and reproductive health conditions (eg, infections, cancers) represent public health concerns for American women. The present study examined how knowledge of the Patient Protection and Affordable Care Act (PPACA) relates to receipt of preventive reproductive health services among women.

DESIGN

Cross-sectional online survey.

SETTING

Online questionnaires were completed via Amazon Mechanical Turk, a crowdsourcing website where individuals complete web-based tasks for compensation.

PARTICIPANTS

Cisgendered women aged 18 to 44 years (N = 1083) from across the United States.

MEASURES

Participants completed online questionnaires assessing demographics, insurance status, preventive service use, and knowledge of PPACA provisions.

ANALYSIS

Chi-squares showed that receipt of well-woman, pelvic, and breast examinations, as well as pap smears, was related to insurance coverage, with those not having coverage at all during the previous year having significantly lower rates of use. Hierarchical logistic regressions determined the independent relationship between PPACA knowledge and use of health services after controlling for demographic factors and insurance status.

RESULTS

Knowledge of PPACA provisions was associated with receiving well-woman, pelvic, and breast examinations, human papillomavirus vaccination, and sexually transmitted infections testing, after controlling for these factors. Results indicate that expanding knowledge about health-care legislation may be beneficial in increasing preventive reproductive health service use among women.

CONCLUSION

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.

Addressing reproductive health disparities as a healthcare management priority: pursuing equity in the era of the Affordable Care Act

PURPOSE OF REVIEW

To summarize the newest available evidence on maternal and reproductive health disparities, and to describe elements of the Affordable Care Act most likely to impact these disparities.

RECENT FINDINGS

Significant racial and ethnic disparities in maternal and reproductive health outcomes have persisted in recent years, contributing to poor outcomes and increasing costs. Pregnancy-related mortality ratios are up to three times higher in Black women compared with non-Hispanic White women, with the risk of severe maternal morbidity also significantly higher in Black and Hispanic women. Unintended pregnancy is twice as likely in minority women. Insurance status, socioeconomic status, and broader social determinants of health are implicated in these disparities. Coverage changes associated with the Affordable Care Act may provide some opportunities to reach communities most at risk. Delivery innovation, payment reform, and further public financing of key services are examples of further management approaches that can be used to address reproductive health disparities.

SUMMARY

The Affordable Care Act offers important opportunities to address persistent reproductive health disparities, but significant gaps remain. Efforts must be made to reduce the negative outcomes and high financial and human costs associated with disparities in reproductive health.

Opting out of cervical cancer screening: physicians who do not perform pap tests

BACKGROUND

Some primary care physicians choose not to provide cervical cancer screening.

PURPOSE

To investigate the characteristics and screening beliefs of family practitioners and internists who treat adult women in outpatient settings but perform no routine Pap tests.

METHODS

A survey of U.S. primary care physicians (N=892) was conducted and analyzed in 2012.

RESULTS

Participants who performed no Pap tests during a typical month (17.2% of family practitioners and 44.3% of internists) generally reported that they referred patients to gynecologists for cervical cancer screening. The most significant predictor of Pap test non-provision was agreement that patients are best served by having Pap tests performed by gynecologists (AOR=8.80, 95% CI=5.58, 13.88, p<0.001).

CONCLUSIONS

The perception that patients benefit from cervical cancer screening administered by gynecologists may deter screening in primary care settings, resulting in missed opportunities to offer screening to women who are never or rarely screened.

Effect of an educational script on postpartum contraceptive use: a randomized controlled trial

OBJECTIVES

Short interpregnancy intervals are associated with adverse perinatal outcomes. Increased postpartum use of long-acting reversible contraception (LARC) could reduce short interpregnancy intervals. Therefore, the primary objective of our study was to evaluate if a postpartum educational script about LARC (LARC script) could increase postpartum LARC utilization at the 6-week postpartum visit.

STUDY DESIGN

We completed a randomized controlled trial (1:1) of 800 postpartum women in Raleigh, North Carolina. Women were recruited from the postpartum unit and randomized to receive (intervention) or not receive (control) the LARC script prior to hospital discharge. We conducted follow-up phone interviews to assess LARC use after their 6-week postpartum visit. We used Pearson's chi-squared test to compare LARC use between arms.

RESULTS

Between May 2011 and January 2012, 400 women were randomized to each arm. Three hundred sixty-nine women (92.3%) in each arm were successfully contacted after their 6-week postpartum visit. LARC use was reported by 17.6% and 13.3% of women in the intervention and control arms, respectively (p=.103).

CONCLUSIONS

The LARC script did not increase LARC utilization at the 6-week postpartum visit. Future studies should evaluate interventions that address both educational and systematic barriers to postpartum LARC uptake.

IMPLICATIONS

Use of a postpartum educational script focused on the intrauterine device and contraceptive implant did not increase their utilization after the 6-week postpartum visit. Future studies should evaluate interventions that address both educational and systematic barriers to postpartum contraceptive uptake.

Organization of Public Health Systems

Public health consists of a complex of activities of public and private organizations working to protect and promote the health of the population, within laws, regulations, legal precedents, and ethics to ensure individual rights as well as those of society. Elected governments in unitary or federal states have legislative, executive, and judicial functions with taxing and enforcement powers. Unitary countries have two levels of government: national and local; federal states have three: federal, state, and local. Each level has official public health responsibilities. Interaction with governmental, non-governmental, and professional organizations, and the public is vital to successful public health. Higher levels of government have greater tax resources, so cost sharing from state and national levels is essential. Low-income countries generally allocate low levels of funding to health and have weak public health infrastructures. Linkages among prevention, health promotion, and medical care are essential to meet population and individual health targets.

Estimated demand for women's health services by 2020

OBJECTIVE

To estimate the demand for women's health care by 2020 using today's national utilization standards.

METHODS

This descriptive study incorporated the most current national data resources to design a simulation model to create a health and economic profile for a representative sample of women from each state. Demand was determined utilizing equations about projected use of obstetrics-gynecology (ob-gyn) services. Applying patient profile and health care demand equations, we estimated the demand for providers in 2010 in each state for comparison with supply based on the 2010 American Medical Association Masterfile. U.S. Census Bureau population projections were used to project women's health care demands in 2020.

RESULTS

The national demand for women's health care is forecast to grow by 6% by 2020. Most (81%) ob-gyn related services will be for women of reproductive age (18-44 years old). Growth in demand is forecast to be highest in states with the greatest population growth (Texas, Florida), where supply is currently less than adequate (western United States), and among Hispanic women. This increase in demand by 2020 will translate into a need for physicians or nonphysician clinicians, which is clinically equivalent to 2,090 full-time ob-gyns.

CONCLUSION

Using today's national norms of ob-gyn related services, a modest growth in women's health care demands is estimated by 2020 that will require a larger provider workforce.