Health Care Funding Changes Impact STI Testing, Study Finds
Universal health coverage and changes in the way Massachusetts funds clinics that test for sexually transmitted infections (STIs) have led to a shift in patients accessing testing that has both positive and negative implications, a study led by BU researchers says.
The study, published in the journal Sexually Transmitted Diseases and led by Mari-Lynn Drainoni, associate professor of health policy and management at BUSPH, found that reductions in state funding and the imposition of fees at STI clinics in 2009 led to a 20 percent decrease in clinic visits. At the same time, STI visits to primary care providers doubled, while there was no increase in visit volume to the emergency room or OB/GYNs.
The authors speculated that, once insured, patients chose to seek STI care in a general, primary care setting, rather than in a designated STI clinic. They noted that most of the increase in STI primary care visits was among women, while STI clinic patients tended to be male.
Drainoni and colleagues said some aspects of the shift were encouraging: “Increased use of health insurance for STI-related care in the ‘medical home’ may help remove some of the stigma associated with use of these services in segregated specialty clinic settings.” But they also found that the drop in patients seen in the STI clinic was not offset by increases in other settings.
“Patients formerly seen in the STI clinic may be delaying or forgoing care, potentially putting themselves and others at risk for disease transmission,” the researchers said, noting that past studies have found that even the imposition of small copayments could discourage patient visits.
The authors also noted that about half of patients who came to the STI clinic paid the fixed fee, rather than bill the visit to insurance.
“Whether anonymity, specialty expertise, or some other factor or combination of factors motivates patients to continue to seek and pay out-of-pocket for STI care in STI specialty settings, it seems that even access to health insurance will not lead all patients to use the medical home (PC) for STI clinical services.”
The authors said their findings indicate that shifting funds from direct service to insurance coverage may have unintended consequences.
“Politicians and policy analysts have argued that such shifts are appropriate because ‘everyone will have insurance’ for necessary services. Our study calls this assumption into question,” they said.
“Rather than conceiving of financing of STI clinical services as all-or-nothing public versus insurance-only options, the focus should be on lowering barriers to quality STI clinical care through various shared-cost mechanisms in multiple settings that allow health care consumers greater choice.”
Besides Drainoni, authors on the study included Drs. Meg Sullivan, Shwetha Sequeira and Katherine Hsu, from the BU School of Medicine, and Janine Bacic, a PhD student at BU.
Submitted by: Lisa Chedekel