Effect of Increased Provider Payments for Provision of Immediate Postpartum Long-Acting Reversible Contraception: Evidence from South Carolina’s Medicaid Policy Change

12-1 pm

PSTC Seminar Room 205

Maria Steenland, Postdoctoral Fellow in Population Studies, Brown University

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Steenland will discuss her study that examines the effect of South Carolina's 2012 Medicaid policy change to begin providing reimbursement for immediate postpartum long-acting reversible contraception (LARCs) separate from the global labor and delivery payment. She created a dataset that included inpatient Medicaid claims for all Medicaid-covered births between 2010–2017 in South Carolina (n=242,979) linked to Medicaid outpatient claims for contraception in the eight weeks after delivery and to birth certificate data. She used an interrupted time series analysis to test whether Medicaid’s policy affected trends in immediate postpartum LARC provision, provision of other forms of inpatient and outpatient postpartum contraception, and short birth intervals (≤ 18 months). All analysis was stratified by age group (i.e., teens and adult women). She finds that the policy change increased the likelihood of immediate postpartum LARC provision by 0.101 (95% CI: 0.076, 0.126, p<0.001) percentage points each month for teens and by 0.071 (95% CI: 0.063, 0.079, p<0.001) for adults. The policy decreased the probably of subsequent childbirth within 18 months of delivery among teens by 0.071 (95% CI: -0.131, -0.012, p=0.011) percentage points per month but had no significant effect on the probability of short birth intervals among adult women. No statistically significant changes in postpartum use of other contraceptive methods were found among teens, but the policy decreased postpartum sterilization, and to a lesser degree, contraceptive injectable use for adult women. Medicaid payment policy changes that provide reimbursement for immediate postpartum LARC provision can be an effective policy option to increase immediate postpartum LARC initiation and increase birth spacing among young women.

Steenland is a health scientist with training in epidemiology, health economics, econometrics, and impact evaluation. Her research uses econometric methods to evaluate maternal and reproductive health programs and policies in sub-Saharan Africa and in the United States. Her previous research has tested the impact of policy changes in patient out-of-pocket costs, provider payments, and service organization on health care provision and utilization. She holds a Master of Public Health in Epidemiology from the University of Michigan and a Doctor of Science in Global Health and Population from the Harvard TH Chan School of Public Health.

Before joining Brown, Steenland worked on an evaluation of a Medicaid payment policy change in South Carolina to increase provision of long-acting reversible contraception to postpartum women. She also evaluated a pilot scheduling system to reduce health facility waiting time for antenatal care in Mozambique and evaluated the impact of performance-based health service financing in Burkina Faso and Cameroon. As a postdoctoral fellow at Brown, Steenland plans to work on a large-scale impact evaluation of appointment scheduling for patients seeking HIV treatment in Mozambique.

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