Association of Insurance Status With Provision of Recommended Services During Comprehensive Postpartum Visits

JAMA Netw Open. 2020 Nov 2;3(11):e2025095. doi: 10.1001/jamanetworkopen.2020.25095.


Importance: Improving care during the postpartum period is a clinical and policy priority. During the comprehensive postpartum visit, guidelines recommend delivery of a large number of assessment, screening, and counseling services. However, little is known about services provided during these visits.

Objective: To examine rates of recommended services during the comprehensive postpartum visits and differences by insurance type.

Design, setting, and participants: This cross-sectional study included 20 071 093 weighted office-based postpartum visits (645 observations) with obstetrical-gynecological or family medicine physicians from annual National Ambulatory Medical Care Surveys from December 28, 2008, to December 31, 2016, and estimated multivariate regression models to calculate the frequency of recommended services by insurance type, controlling for visit, patient, and physician characteristics. Data analysis was conducted from November 1, 2019, to September 1, 2020.

Exposures: Visit paid by Medicaid vs other payment types.

Main outcomes and measures: Visit length and binary indicators of blood pressure measurement, depression screening, contraceptive counseling or provision, pelvic examinations, Papanicolaou tests, breast examinations, medication ordered or provided, referral to other physician, and counseling for weight reduction, exercise, stress management, diet and/or nutrition, and tobacco use.

Results: A total of 20 071 093 weighted comprehensive postpartum visits to office-based family medicine or obstetrical-gynecological physicians were included (mean patient age, 29.7 [95% CI, 29.1-30.3] years). Of these visits, 34.3% (95% CI, 27.6%-41.1%) were covered by Medicaid. Mean visit length was 17.4 (95% CI, 16.4-18.5) minutes. The most common procedures were blood pressure measurement (91.1% [95% CI, 88.0%-94.2%]), pelvic examinations (47.3% [95% CI, 40.8%-53.7%]), and contraception counseling or provision (43.8% [95% CI, 38.2%-49.3%]). Screening for depression (8.7% [95% CI, 4.1%-12.2%]) was less common. When controlling for visit, patient, and physician characteristics, the only significant difference in visit length or provision of recommended services based on insurance type was a difference in provision of breast examinations (14.7% [95% CI, 8.0%-21.5%] for Medicaid vs 25.6% [95% CI, 19.4%-31.8%] for non-Medicaid; P = .02).

Conclusions and relevance: These findings suggest that receipt of recommended services during comprehensive postpartum visits is less than 50% for most services and is similar across insurance types. These findings underscore the importance of efforts to reconceptualize postpartum care to ensure women have access to a range of supports to manage their health during this sensitive period.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Counseling
  • Cross-Sectional Studies
  • Depression / diagnosis
  • Depression / prevention & control
  • Family Planning Services / statistics & numerical data
  • Female
  • Gynecological Examination / statistics & numerical data
  • Health Care Surveys / methods
  • Health Services Accessibility / standards
  • Humans
  • Insurance Coverage / statistics & numerical data*
  • Insurance Coverage / trends
  • Mass Screening / methods
  • Medicaid / statistics & numerical data*
  • Office Visits / statistics & numerical data*
  • Office Visits / trends
  • Postnatal Care / standards*
  • Referral and Consultation / statistics & numerical data
  • United States / epidemiology