ABORTION-RELATED COSTS AS CATASTROPHIC HEALTH EXPENDITURES AND THEIR ASSOCIATIONS WITH IN-STATE OR OUT-OF-STATE TRAVEL TO ABORTION CARE

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception Pub Date : 2024-10-07 DOI:10.1016/j.contraception.2024.110559

O Wasser, L Ralph, S Kaller, MA Biggs

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引用次数: 0

Abstract

Objectives

We aimed to estimate the proportion of people seeking abortion whose out-of-pocket abortion-related costs constitute a catastrophic health expenditure (CHE) and whether these are associated with in-state or out-of-state travel for care.

Methods

In 2019, we surveyed people aged 15–45 seeking abortion in four clinics located in abortion-supportive states that serve many out-of-state patients. We calculated participants’ out-of-pocket abortion-related costs (procedure, transportation, accommodation, childcare, previous appointments, missed work, and other expenses) and assessed whether these costs were financially catastrophic by applying a 40% threshold to their estimated non-subsistence monthly household income, based on published methods (Zuniga et al, 2020). Using multivariable Poisson regressions, we examined associations between traveling in-state or out-of-state for care and experiencing abortion-related costs as CHE.

Results

784 people (of 1,092 approached) completed the survey; 675 responded to the abortion-related costs questions. We found that 42% of participants experienced out-of-pocket abortion-related costs as financially catastrophic. Patients who traveled out-of-state for care were significantly more likely to experience abortion-related costs as CHE (65%, adjusted Prevalence Ratio (aPR) 2.24, 95% confidence interval (CI) 1.67-3.00) than in-state patients (32%). Individuals who resided more than 100 miles from the clinic (aPR 2.05, 95% CI 1.54-2.74) or sought abortion beyond 13 weeks’ gestation (aPR 1.80, 95% CI 1.30-2.51) were also significantly more likely to experience abortion as CHE, compared to their counterparts.

Conclusions

Out-of-pocket costs for abortion care are financially catastrophic for many abortion patients, especially those traveling out-of-state. The adverse impact on people’s financial well-being is likely exacerbated post-Dobbs v Jackson Women’s Health Organization, where more people are traveling for abortion care.

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作为灾难性医疗支出的人工流产相关费用及其与州内或州外人工流产护理旅行的关系

目标我们旨在估算寻求人工流产的人群中自付人工流产相关费用构成灾难性医疗支出（CHE）的比例，以及这些费用是否与州内或州外的就医旅行有关。方法2019 年，我们在位于支持人工流产州的四家诊所对寻求人工流产的 15-45 岁人群进行了调查，这些诊所为许多州外患者提供服务。我们计算了参与者自付的人工流产相关费用（手术、交通、住宿、儿童保育、之前的预约、误工及其他费用），并根据已公布的方法（Zuniga et al，2020 年），对其估计的非自给性家庭月收入采用 40% 的阈值，以评估这些费用是否具有经济灾难性。利用多变量泊松回归，我们研究了州内或州外就医与经历与流产相关的费用之间的关联。结果有 784 人（共 1092 人）完成了调查；675 人回答了与流产相关的费用问题。我们发现，42% 的参与者认为自付的人工流产相关费用在经济上是灾难性的。与州内患者（32%）相比，前往州外接受治疗的患者更有可能将人工流产相关费用视为灾难性费用（65%，调整流行率 (aPR) 2.24，95% 置信区间 (CI)1.67-3.00）。与同类患者相比，居住地距离诊所超过 100 英里（aPR 2.05，95% 置信区间 1.54-2.74）或寻求妊娠超过 13 周的人工流产（aPR 1.80，95% 置信区间 1.30-2.51）的患者经历 CHE 人工流产的可能性也明显更高。多布斯诉杰克逊妇女健康组织一案发生后，越来越多的人前往州外接受堕胎治疗，这可能会加剧对人们经济福祉的不利影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Contraception 医学-妇产科学

CiteScore

4.70

自引率

17.20%

发文量

211

审稿时长

69 days

期刊介绍： Contraception has an open access mirror journal Contraception: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal Contraception wishes to advance reproductive health through the rapid publication of the best and most interesting new scholarship regarding contraception and related fields such as abortion. The journal welcomes manuscripts from investigators working in the laboratory, clinical and social sciences, as well as public health and health professions education.