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

Abstract Background Health disparities research’s goals are to identify facilitators and barriers to health care utilization to help eliminate health inequalities. There are few studies on disparities in health care access and utilization trends for endometriosis patients that may lead to differences in appropriate care based on socioeconomic status. Objective This retrospective cross-sectional study was conducted to compare health services utilization patterns and prevalence of co-morbidities of women with endometriosis with public (government-based) vs. private (purchased or provided by employer) health insurance. Study Design A total of 342 de-identified datasets (171 randomly-selected cases per study group) from women with endometriosis 14-50 years-old, 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 one endometriosis-related medical claim (ICD-9-617.xx; International Classification of Diseases, Ninth Revision, Clinical Modification) during the three-year study period. Results Medical service (e.g., hospital, laboratory, pathology and radiology) utilization trends were 3 times lower in the public vs. the private sector. Women in the public sector were 3.5 less likely to have a laparoscopy, 2.7 times more likely to be prescribed opioid/narcotics, and were the only study subjects reporting emergency room use. Ob/Gyn services were utilized >2-fold less by women in the public (29.5%) vs. the private sector (70.5%) (p=0.087). Conclusion We report significant differences in the utilization trends of endometriosis-related medical services and prescriptions, indicating differences in health care access based on socioeconomic parameters. Our results support development of public health programs to promote access to health care for endometriosis patients irrespective of socioeconomic status and promote health disparity research in other health care systems.