Early postpartum access to highly effective reversible contraceptives [intrauterine
contraceptives (IUCs) and the implant] and sterilization is key to helping women prevent
unintended pregnancy [
[1]
]. However, most current hospital reimbursement policies deny postpartum women access
to IUCs and implants prior to hospital discharge. For women whose deliveries are covered
by private insurance or Medicaid, hospitals receive a global fee based on the diagnosis-related
group (DRG) for all delivery-related care. Postpartum sterilization is carved out
by insurance companies and Medicaid as a procedure that may be billed separately from
the global fee, which in turn means that hospitals are not financially driven to deny
such procedures. In contrast, in most states, postpartum IUCs and implants are not
carved out for separate reimbursement and the costs of the devices must be deducted
from the DRG payment. Since the wholesale acquisition costs for IUCs and implants
range from US$600 to US$775, covering those costs would be fiscally rash. Consequently,
most hospitals do not permit postpartum placement of the most effective reversible
methods, a policy that not only hinders women's ability to space their pregnancies
but also prohibits an important option for those who have completed childbearing but
do not wish to be sterilized. Equally, for women who are covered by Medicaid and desire
postpartum sterilization, the twin requirements of a minimum 30-day waiting period
after signing the consent form and having that form present in the delivery room still
inhibit access [
[2]
]. For these women, postpartum placement of IUCs and implants would be a valuable alternative.
Although the Affordable Care Act may go a long way toward expanding outpatient access
to the most effective methods of contraception, it does not specifically facilitate
inpatient access to IUC or the implant for new mothers prior to hospital discharge.To read this article in full you will need to make a payment
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References
- Postpartum contraception: optimizing interpregnancy intervals.Contraception. 2014; 89: 487-488
- Medicaid policy on sterilization — anachronistic or still relevant?.N Engl J Med. 2014; 370: 102-104
- Advocating for immediate postpartum LARC: increasing access, improving outcomes, and decreasing cost.Contraception. 2014; (in press. Available online athttp://www.sciencedirect.com/science/journal/aip/00107824)
- Postplacental or delayed levonorgestrel intrauterine device insertion and breast-feeding duration.Contraception. 2011; 84: 499-504
- Postplacental or delayed insertion of the levonorgestrel intrauterine device after vaginal delivery: a randomized controlled trial.Obstet Gynecol. 2010; 116: 1079-1087
- Clinical outcomes of early postplacental insertion of intrauterine contraceptive devices.Contraception. 2004; 69: 279-282
- Postplacental insertion of the levonorgestrel intrauterine device after cesarean delivery vs. delayed insertion: a randomized controlled trial.Contraception. 2014; 89: 534-539
- Rapid repeat pregnancy in adolescents: do immediate postpartum contraceptive implants make a difference?.Am J Obstet Gynecol. 2012; 206: 481.e1-481.e7
- Unmet demand for highly effective postpartum contraception in Texas.Contraception. 2014; (in press. Available online athttp://www.sciencedirect.com/science/journal/aip/00107824)
- Choosing a contraceptive: efficacy, safety, and personal considerations.in: Hatcher R.A. Trussell J. Nelson A.L. Cates W. Kowal D. Policar M. Contraceptive Technology: Twentieth. Revised ed. Ardent Media, New York NY2011: 45-74
- Preventing repeat pregnancy in adolescents: is immediate postpartum insertion of the contraceptive implant cost effective?.Am J Obstet Gynecol. 2014; 211: 24.e1-24.e7
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Article info
Publication history
Published online: August 07, 2014
Accepted:
August 6,
2014
Received:
July 21,
2014
Footnotes
☆Author Disclosures: ARAA: none. MDC: Consultant for Merck and receives research support from Medicines360 and Merck. AMK: The Department of Obstetrics and Gynecology at the University of Florida College of Medicine–Jacksonville receives research funds from Bayer and Teva. Dr. Kaunitz is a member of Actavis, Bayer, Merck and Teva advisory boards. ALN: Dr. Nelson is a consultant or advisory board member for Actavis, Bayer, ContraMed, Medicus, Merck, MicroCHIPS, Pharmanest and Teva and is on the speakers bureau for Actavis, Bayer, Merck, Pfizer and Teva. She receives research support from Bayer, Merck, Pfizer and Teva. JT: Consultant to Bayer and is a member of Merck and Teva advisory boards.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
