title: The impact of out-of-pocket expense on IUD utilization among women with private insurance.
abstract: BACKGROUND
  The study was conducted to evaluate the impact of out-of-pocket expense on intrauterine device (IUD) utilization among women with private insurance.
  
  
  METHODS
  We reviewed the records of all women with private insurance who requested an IUD for contraception from an urban academic gynecology practice from May 2007 through April 2008. For each patient, we determined the out-of-pocket expense that would be incurred and whether she ultimately had an IUD placed. The total charge for placement of a copper or levonorgestrel IUD (including the device) was $815.
  
  
  RESULTS
  Ninety-five women requested an IUD during the study period. The distribution of out-of-pocket expense was bimodal: less than $50 for 35 (37%) women and greater than $500 for 52 (55%) women. Intrauterine device insertion occurred in 24 (25%) women, 19 of whom had an out-of-pocket expense less than $50. In univariate and multivariable analysis, women with insurance coverage that resulted in less than $50 out-of-pocket expense for the IUD were more likely to have an IUD placed than women required to pay $50 or more (adjusted odds ratio=11.4, 95% confidence interval=3.6-36.6).
  
  
  CONCLUSIONS
  Women requesting an IUD for contraception are significantly more likely to have an IUD placed when out-of-pocket expense is less than $50.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA. aileen.gariepy@yale.edu
authors.forename: Aileen M
authors.initials: AM
authors.lastname: Gariepy
authors.forename: Erica J
authors.initials: EJ
authors.lastname: Simon
authors.forename: Divya A
authors.initials: DA
authors.lastname: Patel
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Creinin
authors.forename: Eleanor B
authors.initials: EB
authors.lastname: Schwarz
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005382:Financing, Personal; D005102:Health Expenditures; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D007348:Insurance, Health / Q000191:economics; D007434:Intrauterine Devices / Q000191:economics*; D007435:Intrauterine Devices, Copper / Q000191:economics; D007436:Intrauterine Devices, Medicated / Q000191:economics; D008499:Medical Records; D010342:Patient Acceptance of Health Care; D015143:Philadelphia; D017149:Private Sector / Q000191:economics; D012189:Retrospective Studies; D014504:Urban Health
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