Disparities in healthcare services in women with endometriosis with public vs private health insurance

• Published in: American journal of obstetrics and gynecology Vol. 221; no. 6; pp. 623.e1 - 623.e11
• Main Authors: Fourquet, Jessica, Zavala, Diego E., Missmer, Stacey, Bracero, Nabal, Romaguera, Josefina, Flores, Idhaliz
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2019
• Subjects: access to care; Adult; Analgesics, Opioid - therapeutic use; Cross-Sectional Studies; Emergency Service, Hospital - statistics & numerical data; endometriosis; Endometriosis - epidemiology; Female; health disparities; health economics; Health Services Accessibility; Healthcare Disparities; Humans; Hysterectomy - statistics & numerical data; Insurance, Health; Laparoscopy - statistics & numerical data; Medicaid; medical claims; Private Sector; Puerto Rico - epidemiology; Retrospective Studies; United States; United States; Puerto Rico; endometriosis; medical claims; health disparities; access to care; health economics
• ISSN: 0002-9378; 1097-6868; 1097-6868
• DOI: 10.1016/j.ajog.2019.06.020

The goals of health disparities research are to identify facilitators and barriers to healthcare use to help eliminate health inequalities. There are few studies on disparities in healthcare access and use trends for patients with endometriosis that may lead to differences in appropriate care based on socioeconomic status. This retrospective, cross-sectional study was conducted to compare health services use patterns and prevalence of co-morbidities of women with endometriosis with public (government-based) vs private (purchased or provided by employer) health insurance. A total of 342 deidentified datasets (171 randomly-selected cases per study group) from women with endometriosis 14–50 years old who were members of one health insurance company that provides both public and private health insurance coverage in Puerto Rico were analyzed. Patients were defined as having at least 1 endometriosis-related medical claim (ICD-9-617.xx; International Classification of Diseases, Ninth Revision, Clinical Modification) during the 3-year study period. Medical service (eg, hospital, laboratory, pathology, and radiology) use trends were 3 times lower in the public vs the private sector. Women in the public sector were 3.5 times less likely to have a laparoscopy, 2.7 times more likely to be prescribed opioid/narcotics, and were the only study subjects reporting emergency department use. Obstetrics and gynecology services were used >2-fold less by women in the public (29.5%) vs the private sector (70.5%) (P=.087). We report significant differences in the use trends of endometriosis-related medical services and prescriptions, indicating differences in healthcare access based on socioeconomic parameters. Our results support the development of public health programs to promote access to healthcare for patients with endometriosis irrespective of socioeconomic status and promote health disparity research in other healthcare systems.