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To determine if cost impacts administration of local anesthesia vs. sedation during abortion procedures by comparing rates of anesthesia provided before and after Illinois mandated Medicaid coverage of abortion.
This is a retrospective cohort study of patients presenting for a first-trimester procedural abortion at Planned Parenthood of Illinois from January 1, 2016 to December 31, 2019. Effective January 1, 2018, Illinois House Bill 40 (HB40) mandated Medicaid coverage of abortions. Our primary outcome was to compare rates of local anesthesia vs. sedation before and after HB40 implementation. Segmented logistic regression models appropriate for an interrupted time series analysis were performed.
Of the 32,259 patients who met inclusion/exclusion criteria, 14,592 had an abortion procedure prior to HB40 and 17,667 had a procedure afterward. When we used an interrupted time series, we found a statistically significant level change in the rates of sedation following HB40, with rates increasing by 5.39% (p=0.0007).
It is well established that abortion can be cost-prohibitive. However, no studies have examined how cost affects the administration of anesthesia during an abortion procedure. An interrupted time series model allows us to adjust for confounders and analyze the effect of HB40 alone. When looking at the period immediately following the mandated Medicaid coverage, we found a statistically significant increase in sedation administration, suggesting that cost may affect the anesthesia that a patient receives.
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