We use changes to Medicaid immediate postpartum policy to test whether non-monetary costs are meaningful obstacles to health care. Medicaid in several states currently covers long-acting reversible contraceptives (LARCs, including IUDs and implants) immediately following delivery of a child, eliminating much of the time-cost and stress associated with obtaining a LARC. Postpartum LARCs can reduce unintended and short-interval pregnancies, which are associated with adverse neonatal outcomes. Births that occur in Catholic-owned hospitals are an ideal control group, because these hospitals are prohibited from offering family-planning services, including LARCs. Using difference-in-differences and individual-level administrative data from Louisiana and New York, we find eliminating non-monetary obstacles increases take-up of a high-value and highly effective form of contraception. Additionally, we find no evidence of crowd-out of outpatient LARCs.

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医疗保健的非金钱障碍：来自产后避孕药的证据

我们利用产后立即医疗补助政策的变化来测试非货币成本是否对医疗保健构成有意义的障碍。目前，一些州的医疗补助涵盖了分娩后立即使用的长效可逆避孕药（LARC，包括宫内节育器和埋植剂），从而消除了与获得 LARC 相关的大部分时间成本和压力。产后 LARC 可以减少意外怀孕和短间隔怀孕，这些怀孕与不良新生儿结局相关。天主教医院的分娩是理想的对照组，因为这些医院被禁止提供计划生育服务，包括 LARC。使用路易斯安那州和纽约州的双重差异和个人层面的行政数据，我们发现，消除非金钱障碍会增加对高价值和高效避孕方式的采用。此外，我们没有发现门诊 LARC 被挤出的证据。