Confidentiality in use of health insurance coverage for reproductive health services

Enhancing Policy Impact for Reproductive Health Equity (EnPIRHE) Project Summary/Abstract- 30 lines The World Health Organization affirms that sexual and reproductive health (SRH) services are integral to the wellbeing and flourishing of individuals and communities. However, societal dynamics of power and oppression

pattern access to these services, presenting disproportionate barriers to younger people, individuals who identify as Black, Indigenous, and people of color (BIPOC individuals), those with disabilities and chronic disease, individuals who are transgender or gender-nonconforming (TGNC individuals), and people of lower

socioeconomic status. One exacerbating factor for these health inequities is the social stigmatization of sexuality, which compels individuals to keep their utilization of SRH services private for fear of negative repercussions, particularly for people who hold minoritized identities. In the United States, one major threat to patient privacy is

the paper trail associated with utilization of health insurance. Health insurance billing and claims processing for commercial insurance plans frequently involve sending an “explanation of benefits” (EOB) to the primary subscriber of the health insurance plan whenever services are provided to any covered family member. When a

person is covered by a parent’s or spouse’s insurance, EOBs are often sent to the primary subscriber, thereby breaching the person’s confidential health information. Concerns about confidentiality related to insurance billing can also compound existing barriers to care faced by multiply marginalized persons. Thus, leading health care

organizations have called for policy change to correct this gap in patient confidentiality, and state governments are increasingly interested in policy solutions to protect individuals’ privacy when using insurance for sensitive services. Massachusetts is one of only seven states that has enacted legislation (the PATCH law) to protect

confidential use of health insurance coverage, and one of only five that extends such protections to commercially insured people of all ages, providing a rare opportunity to understand individuals’ utilization of, knowledge of, and attitudes toward such policy protections. How this novel policy intervention has affected individuals’ attitudes

towards and ability to utilize insurance for sensitive health services has not been studied. We propose to fill this critical gap in the literature through a mixed-methods study that will directly query SRH service users on their knowledge of, attitudes towards, and intention to use the protections of the PATCH law. This novel inquiry will

be grounded in an intersectional framework, will engage a diverse statewide patient population, and will use a mixed methods approach including survey data and qualitative interviews to understand barriers to insurance utilization, with the goal of improving future health policy interventions.