Women’s Health
Effect of universal, no-cost contraception coverage on gynecological procedure volume: a population-based interrupted time series analysis Laura Schummers* Laura Schummers Schummers Schummers Schummers Schummers Schummers Schummers University of British Columbia
Background: Long-acting reversible contraception (LARC, e.g., intrauterine devices), may reduce the need for gynecological procedures for abnormal uterine bleeding or permanent contraception. In Canada, physician visits and procedures are covered through public insurance; prescription medications/devices are generally covered through a mix of public and private insurance or out-of-pocket by patients. In 2023, British Columbia introduced universal no-cost prescription contraception coverage. This policy substantially increased LARC use, though impacts on gynecological procedure volumes remain unknown.
Methods: Using population-based linked health administrative data, we used physician billing, hospitalization, and emergency department records to identify endometrial ablation, hysterectomy, salpingectomy, and tubal ligation procedures in a cohort of provincially insured female BC residents from 2017-2024. We excluded events with a recent cancer or uterine prolapse diagnosis. We used an interrupted time-series analysis to estimate level and trend changes in monthly procedure rates (per 10,000 females) and compared observed to expected (counterfactual) rates as of December 2024.
Results: We identified 101,686 gynecological procedures from 2017-2024. Pre-policy, there were 8 (CI 7, 9) procedures per 10,000 females/month, increasing by 0.08 (CI 0.03, 0.12) per month. After the policy change, there was an immediate nonsignificant reduction in the procedure rate (-0.41; CI −0.83, 0.02), followed by a significant decline in the trend (-0.06; CI -0.11, -0.02 per 10,000 females/month). By December 2024, there were 1.6 fewer procedures per 10,000 females/month than expected without the policy change, amounting to an 18% volume reduction.
Conclusion: Universal no-cost contraception coverage reduced gynecological procedure volume. Expanded contraceptive access may reduce downstream demand for resource-intensive procedures for permanent contraception or abnormal uterine bleeding.
