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PubMed1970

Family planning.

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District of Columbia↗
PubMedDate not supplied

Public funding of contraceptive, sterilization and abortion services, 1982.

The federal government and the states spent $328 million to support the provision of contraceptive services in fiscal 1982, 13 percent less than they had spent the previous year. Federal funds for family planning services came from Title X of the Public Health Service Act, Title XIX of the Social Security Act (Medicaid), and the Maternal and Child Health (MCH) and Social Services block grants, which are administered by the states. Title X continued to provide the largest, although a diminishing, share of public funds for contraceptive services--36 percent of all such funds in 1982. (In 1980, Title X had accounted for 44 percent of public funding.) Medicaid expenditures for family planning totaled $94 million; $17 million was spent under the MCH block grant, and $46 million under the Social Services block grant. State governments contributed an additional $53 million, about the same figure reported for the previous year, indicating that the states did not use their own funds to soften the impact of cuts in federal expenditures for contraceptive services in 1982. The federal government and the states spent an estimated $55 million, almost all of it through Medicaid, to provide sterilization services for poor women. The states spent $67 million and the federal government spent $1 million to provide abortions for 210,000 indigent women. These figures come from the 11th annual survey of state health and welfare agencies and state Medicaid programs by The Alan Guttmacher Institute (AGI). The AGI conducted this survey in January 1983 to determine the levels and sources of public funding for contraceptive, sterilization and abortion services in each state during FY 1982.

Abortion, Legal↗
PubMedDate not supplied

Public funding for contraceptive, sterilization and abortion services, 1994.

In 1994, federal and state funding for contraceptive services and supplies reached +715 million. Funding totaled +148 million for contraceptive sterilization and +90 million for abortion services. According to a survey of state health, Medicaid and social service agencies, reported spending on contraceptive services and supplies increased by 11% between 1992 and 1994. In the same period, spending under Title X rose by 37%, making it the third largest public funding source for contraceptive services and supplies. The largest source of public funds for family planning services continues to be the joint federal-state Medicaid program. Medicaid family planning expenditures increased by only 4% between 1992 and 1994, a sizable decrease in growth from previous years. State funds continue to be the second largest source, providing almost one-quarter of reported public expenditures in 1994. The maternal and child health and social services block grants remain relatively minor sources of support nationally, although in a handful of states they provide the majority of public-sector funds. State governments were virtually the sole source of public support for the 203,200 abortions provided in 1994 to low-income women. Despite the loosening of federal abortion funding criteria in FY 1994 permitting payment in cases of rape and incest, federally funded abortions numbered only 282.

Abortion, Legal↗
PubMedDate not supplied

Impact of publicly funded contraceptive services on unintended pregnancies and implications for Medicaid expenditures.

Of U.S. women who use a reversible method of contraception, 24% each year obtain family planning services from a publicly funded clinic or a private doctor reimbursed by Medicaid. If these subsidized contraceptive services were not available, women who currently use them would have an estimated 1.3 million additional unplanned pregnancies annually, of which 29% would involve women aged 15-19, 67% would involve never-married women and 61% would involve women with a household income below 200% of the federal poverty level. An estimated 632,300 of these pregnancies would end in induced abortion, an increase of 40% over the current national level. Another 533,800 pregnancies would result in unintended births. Some 76,400 of these would be births to families already receiving public assistance, and 64,100 would be to families that would become eligible for public assistance because of the birth; another 197,000 would be to women whose families would not receive public assistance, but would be eligible for Medicaid coverage of pregnancy, delivery and newborn care. In FY 1987, public-sector expenditures for contraceptive services totaled an estimated $412 million. If subsidized services had not been available, the federal and state governments would have spent an additional $1.2 billion through their Medicaid programs for expenses associated with unplanned births and abortions. Thus, for every dollar spent to provide publicly funded contraceptive services, an average of $3.00 was saved in Medical costs for pregnancy-related health care and medical care for newborns.

Abortion, Induced↗
PubMedDate not supplied

Comparative costs of family planning services and hospital-based maternity care in Turkey.

The costs of running a recently established family planning program in the Turkish social security system were measured and compared with the costs of providing the medical services and nonmedical benefits for pregnant women. The undiscounted cost savings from averting pregnancy were estimated to exceed the program's recurrent costs by 17.6 to 1. Cost savings represent only 1 percent of all of the system's medical expenditures, but the family planning program is in an early stage, and potential savings could influence management decisionmaking regarding investments in specialized maternity hospitals.

Cost Savings↗
PubMed1998

Screening women for chlamydia trachomatis in family planning clinics: the cost-effectiveness of DNA amplification assays.

BACKGROUND: Highly sensitive and specific DNA amplification assays are available for use on cervical and urine specimens. These new tests have the potential to identify more chlamydial infections than the commonly used enzyme immunoassay and DNA probe tests, yet they are more expensive. This study sought to assess the cost effectiveness of cell culture, enzyme immunoassay (EIA), DNA probe (Pace 2), polymerase chain reaction (PCR) of cervical and urine specimens, and ligase chain reaction (LCR) of cervical and urine specimens as screening tools for Chlamydia trachomatis in asymptomatic women younger than 30 years of age attending family planning clinics. STUDY DESIGN: Program costs; medical cost savings of prevented sequelae in women, male sex partners, and infant; and number of prevented cases of pelvic inflammatory disease (PID), neonatal infections, and male sex partner urethritis and epididymitis were modeled in a decision analysis conducted from a health care system perspective. Results are expressed for a cohort of 18,000 women. RESULTS: If no screening for C. trachomatis were conducted in Maryland, 497 cases of PID would develop, costing $2.2 million in future medical costs. Use of EIA to detect chlamydial infection would prevent 240 cases of PID and save $887,000 over no screening. Alternatively, use of DNA amplification assays on urine specimens would prevent up to an additional 66 cases and save $287,100 over EIA. Use of LCR on cervical specimens would prevent at least 13 additional cases of PID over the urine-based assays, but would cost $3,005 for each additional case prevented. In women receiving routine pelvic examinations, LCR of cervical specimens would prevent the most disease and provide the highest cost savings. In women not receiving routine pelvic examinations, use of LCR on cervical specimens would prevent the most disease but would cost approximately $28,000 per additional case of PID prevented over DNA amplification of urine. CONCLUSIONS: Compared with EIA screening, the strategy with the lowest program costs, a screening strategy that combines use of DNA amplification on cervical specimens in women receiving pelvic examinations, and DNA amplification of urine in women with no medical indications necessitating a pelvic examination, prevents the most cases of PID and provides the highest cost savings. With enhanced sensitivity over the other diagnostic assays and with the use of noninvasive specimen collection, DNA amplification assays should be implemented as cost-effective components of a screening program for C. trachomatis.

Adult↗
PubMedDate not supplied

Health USA. A national health program for the United States.

The Health USA Act of 1991 addresses two fundamental health services financing problems: the more than 30 million uninsured persons and the rising costs for health care and for health insurance. Health USA would provide coverage of the entire resident population for comprehensive medical and preventive health and long-term care services through a universal tax-funded financing system. The federal government would contribute an average of 87% of program costs to each state, which would establish, under federal guidelines, a state health program. Each individual or family may enroll in any health plan approved by the state program, including many private plans, or a plan run by the state program. Through the approved plan of their choice, enrollees would receive covered services and obtain their care from participating physicians and other professional practitioners, hospitals, and other facilities. The state program would pay approved plans a capitation payment for every person enrolled. The plans would pay professional providers fees, as part of an all-payer system of fee schedules and expenditure targets, or capitation payments or salary. Hospitals would be financed through global budgets negotiated by the state program with each hospital. The plan run by the state program would pay the health care costs of any person who does not enroll in an approved plan, making the state plan the payer of last resort and eliminating uncompensated care and cost shifting by providers. Health USA would separate health care coverage from employment, ensuring uninterrupted coverage and eliminating employers' administrative role in providing coverage. Federal and state taxes would replace present methods of financing by private insurance premiums and large out-of-pocket expenditures. Building on the present system of health plans, Health USA would offer all persons a wide choice of competing plans in which to enroll and offer professional providers a wide choice of plans in which to practice. It would control costs by increasing financial accountability of providers and health plans, reducing present reliance on intrusive utilization review and on patient cost sharing. By controlling health care and administrative costs, Health USA would cover the entire population and, according to independent cost estimates, reduce national health expenditures by $11.5 billion in 1991.

Cost Control↗
PubMed1995

The economic value of contraception: a comparison of 15 methods.

OBJECTIVES: The purpose of the study was to determine the clinical and economic impact of alternative contraceptive methods. METHODS: Direct medical costs (method use, side effects, and unintended pregnancies) associated with 15 contraceptive methods were modeled from the perspectives of a private payer and a publicly funded program. Cost data were drawn from a national claims database and MediCal. The main outcome measures included 1-year and 5-year costs and number of pregnancies avoided compared with use of no contraceptive method. RESULTS: All 15 contraceptives were more effective and less costly than no method. Over 5 years, the copper-T IUD, vasectomy, the contraceptive implant, and the injectable contraceptive were the most cost-effective, saving $14,122, $13,899, $13,813, and $13,373, respectively, and preventing approximately the same number of pregnancies (4.2) per person. Because of their high failure rates, barrier methods, spermicides, withdrawal, and periodic abstinence were costly but still saved from $8933 to $12,239 over 5 years. Oral contraceptives fell between these groups, costing $1784 over 5 years, saving $12,879, and preventing 4.1 pregnancies. CONCLUSIONS: Contraceptives save health care resources by preventing unintended pregnancies. Up-front acquisition costs are inaccurate predictors of the total economic costs of competing contraceptive methods.

Contraception↗
PubMed1998

Screening for Chlamydia trachomatis in asymptomatic women attending family planning clinics. A cost-effectiveness analysis of three strategies.

BACKGROUND: Screening women for Chlamydia trachomatis in family planning clinics is associated with a reduced incidence of chlamydial sequelae. However, the question of whom to screen to maintain efficient use of resources remains controversial. OBJECTIVE: To assess the cost-effectiveness of chlamydial screening done according to three sets of criteria in asymptomatic women attending family planning clinics. DESIGN: Cost-effectiveness analysis done by using a decision model with the perspective of a health care system. Model estimates were based on analysis of cohort data, clinic costs, laboratory costs, and published data. SETTING: Two family planning clinics in Baltimore, Maryland. PATIENTS: 7699 asymptomatic women who presented between April 1994 and August 1996. INTERVENTION: Three screening strategies--screening according to the criteria of the Centers for Disease Control and Prevention (CDC), screening all women younger than 30 years of age, and universal screening--were retrospectively applied and compared. All women were tested with polymerase chain reaction. MEASUREMENTS: Medical outcomes included sequelae prevented in women, men, and infants. Total costs included screening program costs and future medical costs of all sequelae. The incremental cost-effectiveness ratios of each strategy were calculated. RESULTS: Without screening, 152 cases of pelvic inflammatory disease would occur at a cost of $676,000. Screening done by using the CDC criteria would prevent 64 cases of pelvic inflammatory disease at a cost savings of $231,000. Screening all women younger than 30 years of age would prevent an additional 21 cases of pelvic inflammatory disease and save $74,000. Universal screening would prevent an additional 6 cases of pelvic inflammatory disease but would cost $19,000 more than age-based screening, or approximately $3000 more per case of pelvic inflammatory disease prevented. If the prevalence of C. trachomatis is more than 10.2% or if less than 88.5% of infections occur in women younger than 30 years of age, universal screening provides the greatest cost savings. CONCLUSIONS: These results suggest that age-based screening provides the greatest cost savings of the three strategies examined. However, universal screening is desirable in some situations. In general, screening done by using any criteria and a highly sensitive diagnostic assay should be part of any chlamydial prevention and control program or health plan.

Adolescent↗
PubMed2001

The long-term effects of Medicaid managed care on obstetrics care in three California counties.

OBJECTIVE: To evaluate the long-term effects of Medicaid managed care (MMC) on obstetric service use and program costs in California. DATA SOURCES/STUDY SETTING: Longitudinal administrative data on Medi-Cal enrollment and claims and encounters related to pregnancy and delivery services were gathered from three counties--two long-standing MMC counties and one traditional fee-for-service Medicaid county--in California between 1987 and 1992. STUDY DESIGN: We studied Aid to Families with Dependent Children (AFDC) beneficiaries with live singleton vaginal deliveries with associated hospital stays of 14 days or less. Effects of managed care were examined with respect to prenatal visits, length of stay for delivery, maternal postpartum readmission rates, and total program expenditures. Multivariate analyses examined how the relative effect of managed care on service use and program expenditures in each MMC county evolves over time in comparison to fee-for-service. We controlled for length of Medi-Cal enrollment prior to delivery, data censoring, and individual characteristics such as race and age. PRINCIPAL FINDINGS: Prenatal care use is consistently lower in the MMC counties, although all three counties' prenatal care provision is well below the national standard. Drastic increases in one-day-stay deliveries were found: up to almost 50 percent of deliveries in MMC counties were one-day stays. Program cost savings associated with MMC enrollment are unambiguous. CONCLUSIONS: MMC cost savings might have come at the expense of reduced provision of prenatal care and shorter delivery length of stay. Future studies should verify any possible causal link and the effects on maternal and infant health outcomes.

Aid to Families with Dependent Children↗