Confidentiality, insurance, and provider-based barriers to sexual and reproductive health services
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This dissertation consists of three studies that examine barriers to sexual and reproductive health care among commercially insured young adults and women. Study 1 investigates differences in insurance use behavior for confidential SRH care by young adults with parental versus policyholder coverage. Findings demonstrate that individuals with parental insurance coverage are less likely than their counterparts with policyholder coverage to use their insurance to pay for pap testing, contraception, sexually transmitted infection (STI) testing, and pre-exposure prophylaxis (PrEP). Study 2 builds on this work to evaluate the role of the national dependent coverage expansion on insurance use for sexual and reproductive health services. Findings demonstrate an aggregate reduction in insurance use for pap testing, contraception, and STI testing among young adult women newly eligible for parental coverage under the expansion. Study 3 examines prevalence and trends in non-indicated pelvic examinations performed during contraceptive visits, along with variations by provider specialty and patient age. Results show a substantial increase in the number of pelvic examinations performed during contraceptive encounters from 2007 – 2017, and higher rates of non-indicated exams performed by obstetrician-gynecologists. Together, this research provides evidence of barriers to sexual and reproductive health care among commercially insured young adults and women, highlighting ongoing issues of patient privacy and autonomy in health care financing and service delivery.