Effects of health insurance coverage on access to contraceptive and preventive gynecologic care

Having health insurance is a predictor of health care access, increasing the likelihood that someone has a regular source of care and obtains appropriate and timely care. This study explores trends in the effects of health insurance coverage on use of any contraceptive or preventive gynecological service, using pooled data from the 1995 and 2002 NSFG surveys. During this period, selected states mandated private coverage or extended Medicaid coverage for contraceptive care, thereby expanding access for selected groups.

We estimated service-specific regression models using a sample of 8,100 white, black, and Hispanic women at risk of unintended pregnancy. We calculated odds ratios and predicted probabilities for selected variables, including the interaction of survey year by type of health insurance coverage. We also tested for differences in the probability of service use between years, by insurance status. In fully adjusted model, the probability of using any contraceptive service increased from 53% in 1995 to 64% in 2002 (p<.001) among the privately insured and increased from 56% to 67% (p<.001) for those with Medicaid/Other public insurance. Between 1995 and 2002, there were nonsignificant increases in the probabilities of using any preventive gynecological services among privately (78% versus 80%) and Medicaid/Other public-insured (83% versus 84%) women, but a significant (p<.05) decrease in use for uninsured women (67% versus 59%). Final models will control for state-level contextual factors affecting financing of contraceptive care.

Efforts to increase access to reproductive health care have not benefited uninsured women, who remain vulnerable to unintended pregnancy and poor reproductive health outcomes.