Dalton VK, et al. - This analysis was undertaken to delineate the relationship between the elimination of out-of-pocket costs and utilization of preventive care visits and long-acting reversible contraception insertion, while taking baseline cost-sharing levels under consideration. Prior to the Affordable Care Act, out-of-pocket costs were low. Increases in preventive service use were noted in association with eliminating costs among those with high levels of cost. However, the low effect sizes suggested cost as only one barrier. Researchers here failed to recognize that cost sharing was already low. This might have led to the false conclusion that the elimination of cost sharing was ineffective.

Methods

• Researchers used administrative health plan data in 2017 to examine changes in out-of-pocket costs and service utilization among 2,172,065 women enrolled in 15,118 employer-based health plans between 2008 and 2015.
• Generalized estimating equations were utilized to examine utilization patterns.

Results

• In this sample, women generally had low costs at baseline ($24 and $29 for preventive care visits and long acting reversible contraception insertion, respectively).
• Researchers noted elimination of baseline out-of-pocket costs to be associated with changes in utilization of both services, but more consistently for contraceptive device placement.
• Women whose low/moderate out-of-pocket costs were eliminated showed more tendency for using a preventive care office visit than women with persistent low/moderate costs (OR 1.05, 95% CI 1.04, 1.05), however, women with high out-of-pocket costs demonstrated lower utilization rates even after elimination of their costs.
• In contrast, when out-of-pocket costs were zero, higher odds of having a contraceptive device placed was noted among all groups of women, as compared to women with low/moderate costs.
• When compared to women with low/moderate costs, women were less likely to have a contraceptive device inserted (OR 0.92, 95% CI 0.86, 0.97) when they had high costs, but more likely after their costs were eliminated (OR 1.15, 95% CI 1.09, 1.20).