Potential unintended pregnancies averted and cost savings associated with a revised Medicaid sterilization policy

Objective

Medicaid sterilization policy, which includes a mandatory 30-day waiting period between consent and the sterilization procedure, poses significant logistical barriers for many women who desire publicly funded sterilization. Our goal was to estimate the number of unintended pregnancies and the associated costs resulting from unfulfilled sterilization requests due to Medicaid policy barriers.

Study Design

We constructed a cost-effectiveness model from the health care payer perspective to determine the incremental cost over a 1-year time horizon of the current Medicaid sterilization policy compared to a hypothetical, revised policy in which women who desire a postpartum sterilization would face significantly reduced barriers. Probability estimates for potential outcomes in the model were based on published sources; costs of Medicaid-funded sterilizations and Medicaid-covered births were based on data from the Medicaid Statistical Information System and The Guttmacher Institute, respectively.

Results

With the implementation of a revised Medicaid sterilization policy, we estimated that the number of fulfilled sterilization requests would increase by 45%, from 53.3% of all women having their sterilization requests fulfilled to 77.5%. Annually, this increase could potentially lead to over 29,000 unintended pregnancies averted and $215 million saved.

Conclusion

A revised Medicaid sterilization policy could potentially honor women’s reproductive decisions, reduce the number of unintended pregnancies and save a significant amount of public funds.

Implication

Compared to the current federal Medicaid sterilization policy, a hypothetical, revised policy that reduces logistical barriers for women who desire publicly funded, postpartum sterilization could potentially avert over 29,000 unintended pregnancies annually and therefore lead to cost savings of $215 million each year.     

Ectopic thyroid: A rare cause of tracheal obstruction

The endoluminal presence of thyroid tissue in the trachea is a rare cause of airway obstruction. Only 14 well documented cases of intratracheal ectopic thyroid tissue have been reported in English Literature since 1966. These lesions are mostly benign and nearly all patients present with symptoms of respiratory obstruction. We present a case of ectopic thyroid in cervical trachea presenting with symptoms of airway obstruction. Thorough clinical examination and investigations were carried out. A right hemithyroidectomy and excision of a part of the tracheal wall through a tracheotomy was performed for removal of the ectopic thyroid tissue from trachea. The clinicians & radiologists must be aware of this entity to avoid mistaking it for evidence of invasion by a malignant neoplas, and hence this report.     

The use of a low-literacy version of the Medicaid sterilization consent form to assess sterilization-related knowledge in Spanish-speaking women: results from a randomized controlled trial

Objective

To learn whether a version of the Medicaid Sterilization Consent Form (SCF) adapted for populations of low-literacy can help Spanish-speaking women better understand the process and consequences of tubal sterilization.

Do instructions for over-the-counter pre-coital female contraceptives promote “perfect use”?

Background

This study was conducted to estimate the readability and related features of English-language over-the-counter (OTC) pre-coital female contraceptive (PFC) instructions.

Study Design

We identified and purchased all currently available OTC PFCs (n=8), including Encare (Contraceptive Gel® and Insert®), F.C. Female Condom®, Ortho Options® (Conceptrol,® Delfen® and Gyncol II Jelly®), Today Sponge® and VCF Vaginal Film®. Reading grade level was calculated using the Simple Measure of Gobbledygook. Text point size was measured and total number of graphics was tallied. Graphic dimensions were also measured. We also assessed OTC PFC instructions on four main criteria — derived from the “User-Friendliness Tool (UFT)” — including layout features, graphic characteristics, presence of a clear message and presentation of manageable information.

Results

Reading level ranged from 8th to 12th grade (mean±SD=10.0±1.2). Mean page length was 24.4±7.0 cm (9.6±2.76 in.), while average page width was 20.3±13.8 cm (7.99±5.43 in.). Average text point size was 7.9±2.3 (range=6-12). Illustrations, predominantly line drawings, were used throughout (range=3-11), and most were similar in size to a matchbox. None of the “How to Use” sections scored high in all criteria on the UFT.

Conclusions

“How to Use” sections of OTC PFC instructions should be revised to be easier to read and more user friendly. Ideally, the gap between “typical” and “perfect” contraceptive efficacy could potentially be narrowed if instructions were developed that the large majority of women could easily understand.