title: Potential unintended pregnancies averted and cost savings associated with a revised Medicaid sterilization policy.
abstract: OBJECTIVE
  Medicaid sterilization policy, which includes a mandatory 30-day waiting period between consent and the sterilization procedure, poses significant logistical barriers for many women who desire publicly funded sterilization. Our goal was to estimate the number of unintended pregnancies and the associated costs resulting from unfulfilled sterilization requests due to Medicaid policy barriers.
  
  
  METHODS
  We constructed a cost-effectiveness model from the health care payer perspective to determine the incremental cost over a 1-year time horizon of the current Medicaid sterilization policy compared to a hypothetical, revised policy in which women who desire a postpartum sterilization would face significantly reduced barriers. Probability estimates for potential outcomes in the model were based on published sources; costs of Medicaid-funded sterilizations and Medicaid-covered births were based on data from the Medicaid Statistical Information System and The Guttmacher Institute, respectively.
  
  
  RESULTS
  With the implementation of a revised Medicaid sterilization policy, we estimated that the number of fulfilled sterilization requests would increase by 45%, from 53.3% of all women having their sterilization requests fulfilled to 77.5%. Annually, this increase could potentially lead to over 29,000 unintended pregnancies averted and $215 million saved.
  
  
  CONCLUSIONS
  A revised Medicaid sterilization policy could potentially honor women's reproductive decisions, reduce the number of unintended pregnancies and save a significant amount of public funds.
  
  
  CONCLUSIONS
  Compared to the current federal Medicaid sterilization policy, a hypothetical, revised policy that reduces logistical barriers for women who desire publicly funded, postpartum sterilization could potentially avert over 29,000 unintended pregnancies annually and therefore lead to cost savings of $215 million each year.
authors.affiliation: Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Center for Health Equity, Research, and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. Electronic address: borrerosp@upmc.edu.
authors.forename: Sonya
authors.initials: S
authors.lastname: Borrero
authors.forename: Nikki
authors.initials: N
authors.lastname: Zite
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Potter
authors.forename: James
authors.initials: J
authors.lastname: Trussell
authors.forename: Kenneth
authors.initials: K
authors.lastname: Smith
mesh_terms: D000328:Adult; D003267:Contraception / Q000191:economics; D017046:Cost Savings / Q000191:economics*; D003362:Cost-Benefit Analysis; D005193:Family Planning Services / Q000191:economics; D005260:Female; D005380:Financing, Government / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D008484:Medicaid / Q000191:economics*; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D013245:Sterilization, Reproductive / Q000191:economics*; D014481:United States
keywords: Cost analysis; Tubal sterilization; Unfulfilled sterilization
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