The association between high-deductible health plan transition and contraception and birth rates

Amy J. Graves, Katy B. Kozhimannil, Ken P. Kleinman, J. Frank Wharam

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objective To evaluate the association between employer-mandated enrollment into high-deductible health plans (HDHPs) and contraception and birth rates among reproductive-age women. Data Sources/Study Setting Using data from 2002 to 2008, we examined 1,559 women continuously enrolled in a Massachusetts health plan for 1 year before and after an employer-mandated switch from an HMO to a HDHP, compared with 2,793 matched women contemporaneously enrolled in an HMO. Study Design We used an individual-level interrupted time series with comparison series design to examine level and trend changes in clinician-provided contraceptives and a differences-in-differences design to assess annual birth rates. Data Collection/Extraction Methods Employer, plan, and member characteristics were obtained from enrollment files. Contraception and childbirth information were extracted from pharmacy and medical claims. Principal Findings Monthly contraception rates were 19.0-24.0 percent at baseline. Level and trend changes did not differ between groups (p =.92 and p =.36, respectively). Annual birth rates declined from 57.1/1,000 to 32.7/1,000 among HDHP members and from 61.9/1,000 to 56.2/1,000 among HMO controls, a 40 percent relative reduction in odds of childbirth (odds ratio = 0.60; p =.02). Conclusions Women who switched to HDHPs experienced a lower birth rate, which might reflect strategies to avoid childbirth-related out-of-pocket costs under HDHPs.

Original languageEnglish (US)
Pages (from-to)187-204
Number of pages18
JournalHealth services research
Issue number1
StatePublished - Feb 1 2016

Bibliographical note

Funding Information:
This work was supported by the Building Interdisciplinary Research Careers in Women’s Health Grant (K12HD055887) from the Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD), the Office of Research on Women’s Health, and the National Institute on Aging, at the National Institutes of Health, administered by the University of Minnesota Deborah E. Powell Center for Women’s Health (Dr. Kozhimannil) and by a Harvard Pilgrim Health Care Foundation grant to Dr. Wharam. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or other funders. We thank Irina Miroshnik, M.S., for assisting with data acquisition.

Publisher Copyright:
© Health Research and Educational Trust.


  • High-deductible
  • childbirth
  • contraception
  • managed care


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