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The effect of parental coverage on insurance-reimbursed utilization of sexual and reproductive health services by young adult women in Massachusetts

Jacqueline Ellison, MPH, Boston University

Young adult women have higher rates of sexually transmitted infection, unintended pregnancy, and abortion then their older counterparts. This age group also disproportionately experiences cost-related barriers to care. Confidentiality concerns related to insurer practices may obstruct insurance use for SRH services by women covered as dependents under a parent's insurance policy, but the relationship between parental coverage status and insurance-reimbursed service utilization has received very little empirical attention. This quasi-experimental research will evaluate the effect of parental coverage status on private insurance-reimbursed utilization of sexual and reproductive health services by young adult women using difference-in-differences econometric and propensity methods with all-payer claims data from Massachusetts. We will evaluate the effects of parental coverage status on insurance use for STI testing, contraception, emergency contraception, and abortion as well as non-stigmatized placebo outcomes (pap tests and sick visits). We hypothesize greater insurance-reimbursed utilization of SRH services by young adult women after aging-out of parental coverage as compared to a matched control group with consistent policyholder coverage. We also hypothesize a greater effect of parental coverage on insurance-reimbursed utilization for stigmatized services by women living in rural areas. Because the purpose of health insurance is to finance the provision of essential health care, the value of dependent coverage is predicated on insurance-reimbursed utilization of services. Understanding the insurance use behavior of young adult women with parental coverage is therefore necessary for a nuanced understanding of access to and payment for needed SRH care.


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