Abortion restrictions could lead to higher ER use
Women who have to travel longer distances to receive abortion services are more than twice as likely to end up getting follow-up care within their local emergency departments, according to a new study, which researchers say raises the cost of such services.
The analysis, published Tuesday in the journal Obstetrics and Gynecology, found that 12% of women traveled more than 50 miles and 4% traveled 100 miles or more to receive their abortion care.
In examining data from nearly 40,000 abortions performed between 2011 and 2012 and covered by California's Medicaid program, Medi-Cal, the researchers found that women who traveled 100 miles or more to get an abortion were only half as likely as women traveling 25 miles or less to go back to their abortion provider for follow-up care. Plus, women traveling at least 100 miles were more than twice as likely to go to their local emergency department. Previous research found more than half of women traveling 50 miles or more for care were rural residents.
Ushma Upadhyay, associate professor of reproductive sciences at the University of California at San Francisco School of Medicine, said the findings could have large implications for the type of follow-up care patients ultimately receive, as well as for the providers delivering such services.
The main issue would be that limiting access may lead to increased ED visits for follow-up care. States whose lawmakers pass tougher abortion restrictions have generally seen a decline in the number of facilities that provide such services. In Texas, a 2013 state law placing tougher limits on abortion access led to 20 clinics clinics in a three-year span, with most occurring in rural areas.
The law resulted in a sharp decline in abortions performed during that period in communities where clinic closures meant the next closest facility was located more than 100 miles away.
Only 3% of the abortions studied were followed by an ED visit, compared to a quarter that were followed by a visit to the original abortion site.
But with fewer facilities that provide such services, the study's findings suggest more hospital emergency departments could turn into de facto clinics for follow-up care as the number of women who have to travel further for abortions increase.
The study found Medicaid costs for follow-up care were consistently higher when performed in an emergency department, where the median cost was $941 per visit, compared to $536 per visit when performed at an abortion clinic. Though federal Medicaid dollars are prohibited from being used to pay for abortion, California is one of 17 states that uses its state contribution to the program to cover the cost of such services.
"I think the largest implication is that they're (patients) not receiving continuity of care," Upadhyay said.
On Tuesday, Texas Gov. Greg Abbott signed a bill that will ban all insurers from covering abortion services in their standard plans, requiring women to pay extra for such coverage in the form of a supplemental insurance plan. The law makes Texas one of eight states to effectively ban insurers from covering abortion care even in the event of rape or incest.
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