title: High-deductible health plans and costs and utilization of maternity care.
abstract: OBJECTIVE
  To evaluate the impact of switching from an HMO to a high-deductible health plan on the costs and utilization of maternity care.
  
  
  METHODS
  Pre–post design, with a control group.
  
  
  METHODS
  We compared 229 women who delivered babies before or after their employers mandated a switch from HMO coverage to a high-deductible health plan, with a control group of 2180 matched women who delivered babies while their employers remained in an HMO plan. Administrative claims from a large Massachusetts-based health insurance program were used in a difference-in-differences regression analysis.
  
  
  RESULTS
  Mean out-of-pocket maternity care costs for high-deductible group members increased from $356 for women who delivered before the insurance transition (n = 86) to $942 for women who delivered after the transition (n = 143), compared with a change from $262 (n = 711) to $282 (n = 1569) for HMO members, a relative increase of 106% (P <.001) for high-deductible members. Delivery after transition to a high-deductible plan was not associated with changes in the odds of receiving early prenatal care (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.32-3.19), recommended prenatal visits (OR, 1.64; 95% CI, 0.89-3.02), or postpartum care (OR, 0.74; 95% CI, 0.42-1.32).
  
  
  CONCLUSIONS
  Switching from an HMO to a high-deductible plan with exemptions for routine care increased out-of-pocket member costs for maternity care, but had no apparent adverse impacts on receipt of recommended prenatal and postpartum care.
authors.affiliation: Department of Population Medicine, Harvard Medical School, Boston, MA, USA. kbk@umn.edu
authors.forename: Katy Backes
authors.initials: KB
authors.lastname: Kozhimannil
authors.forename: Haiden A
authors.initials: HA
authors.lastname: Huskamp
authors.forename: Amy Johnson
authors.initials: AJ
authors.lastname: Graves
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
authors.forename: J Frank
authors.initials: JF
authors.lastname: Wharam
mesh_terms: D000328:Adult; D003669:Deductibles and Coinsurance / Q000191:economics* / Q000639:trends; D005260:Female; D017048:Health Care Costs; D006279:Health Maintenance Organizations / Q000191:economics* / Q000639:trends; D006771:Hospitals, Maternity / Q000191:economics* / Q000639:trends; D006801:Humans; D007345:Insurance Claim Review / Q000191:economics / Q000639:trends; D019458:Insurance Coverage / Q000706:statistics & numerical data / Q000639:trends; D008404:Massachusetts; D011181:Postnatal Care / Q000191:economics / Q000639:trends; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics* / Q000639:trends; D012044:Regression Analysis; D013997:Time Factors; D014481:United States