The financial effects of expanding postpartum contraception for new immigrants.
OBJECTIVE
To estimate the costs of expanding Emergency Medicaid coverage to include postpartum contraception.


METHODS
A decision-analytic model was developed using three perspectives: the hospital, state Medicaid programs, and society. Our primary outcome was future reproductive health care costs due to pregnancy in the next 5 years. A Markov structure was use to analyze the probability of pregnancy over a 5-year time period. Model inputs were retrieved from the existing literature and local hospital and Medicaid data related to reimbursements. One-way and multiway sensitivity analyses were conducted. A Monte Carlo simulation was performed to incorporate uncertainty from all of the model inputs simultaneously.


RESULTS
Over a 5-year period, provision of contraception would save society $17,792 per woman in future pregnancy costs and incur a loss of $367 for hospitals. In states in which 49% of immigrants remain in the area for 5 years, such a program would save state Medicaid $108 per woman.


CONCLUSIONS
Under federal regulations, new immigrants are restricted to acute, hospital-based care only. Failure to provide the option of contraception postpartum results in increased costs for society and states with long-term immigrants.
Rodriguez
Maria Isabel
MI
From the Department of Obstetrics, Gynecology, and Reproductive Sciences and the Center for Clinical and Policy Perinatal Research (CPR), University of California, San Francisco, San Francisco, California; the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and the Department of Obstetrics, Gynecology, and Reproductive Sciences, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, Massachusetts.
Jensen
Jeffrey T
JT
Darney
Philip D
PD
Little
Sarah E
SE
Caughey
Aaron B
AB
D000328:Adult; D003267:Contraception / Q000191:economics*; D003362:Cost-Benefit Analysis; D054242:Emigrants and Immigrants; D005193:Family Planning Services / Q000191:economics; D005260:Female; D006801:Humans; D008484:Medicaid / Q000191:economics*; D009010:Monte Carlo Method; D011181:Postnatal Care / Q000191:economics* / Q000379:methods; D014481:United States