Parental Coverage and Insurance Use Behavior of Young Women for Sexual and Reproductive Health Services in Massachusetts

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. Unlike most other health services, use of sexual and reproductive health (SRH) care is likely sensitive to confidentiality concerns, thereby obstructing insurance use for these services. To measure the sensitivity of SRH services to confidentiality concerns, this study contrasts the use of SRH services as young adult women transition from insurance coverage as dependents under a parent's insurance policy to self-coverage (i.e., policyholders). We use comprehensive Massachusetts all-payer claims data from 2011-2017 to obtain measures of longitudinal health services utilization.

Applying a difference-in-differences design, we estimate the effect of parental coverage status on insurance use for STI testing, contraception, and abortion as well as non-confidential placebo outcomes, flu shots and sick visits. We match the treatment group- women aged 23-29 with private insurance coverage who switch from parental to policyholder coverage upon becoming ineligible for parental coverage at age 26, with a control group of the same age- women with consistent policyholder coverage before and after the eligibility threshold. Women with Medicaid coverage are included as an alternative control group in the sensitivity analysis. Our outcomes are estimated using linear probability models, adjusting for health plan, payment, and zip code-level sociodemographic and provider availability proxies. Our preliminary analysis demonstrates differences in insurance-reimbursed service utilization between women with parental and policyholder coverage. Women aged 23-25 with parental insurance were less likely to have used their insurance for STI testing, contraception, or abortion (45.3%, 14.5%, and 1.5%, respectively) than their policyholder counterparts in the same age range (54.9%, 23.4%, and 4.2%). We hypothesize greater insurance use for SRH services by young adult women after aging-out of parental coverage as compared to the matched control group with consistent policyholder coverage, and no difference in use of placebo outcomes, which should not be sensitive to treatment status.