Continuing Need for Sexually Transmitted Disease Clinics After the Affordable Care Act

Hoover, Karen W.; Parsell, Bradley W.; Leichliter, Jami S.; Habel, Melissa A.; Tao, Guoyu; Pearson, William S.; Gift, Thomas L.

doi:10.2105/ajph.2015.302839

Cited by 47 publications

(52 citation statements)

References 19 publications

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“…Forecasting the potential mix may be difficult, given that patients have options to use or not use insurance, and their desire to use or not use insurance may change based on type of insurance, amount of copays and deductibles, or non-financial reasons. 12,13,15 Further complicating estimates is that private insurance and institutional list reimbursement rates are not publicly available, are not standardized across patients or hospitals, and are often negotiated on a per insurer or health system basis. By using 2015 Medicaid rates, which represent the minimum cost that would be reimbursed, this analysis provides a conservative baseline estimate of the number of visits that would need to be covered based on rates that are standardized and known.…”

Section: Discussionmentioning

confidence: 99%

“…11–14 Patients with health insurance may continue to use safety-net services because of non-monetary considerations, such as the desire to keep STD testing history private from primary care providers, insurers, or family members who share an insurance plan. 12,13,15 STD clinics may also be perceived as providing higher quality STD care services 12 or as being more inclusive of gender and sexual minority patients compared with general practices. 12 Financial barriers to seeking STD services from traditional medical establishments may also persist among the insured through cost sharing via copays or deductibles.…”

Section: Introductionmentioning

confidence: 99%

“…12,13,15 STD clinics may also be perceived as providing higher quality STD care services 12 or as being more inclusive of gender and sexual minority patients compared with general practices. 12 Financial barriers to seeking STD services from traditional medical establishments may also persist among the insured through cost sharing via copays or deductibles. 15 These clinics provide rapid treatment, as a patient may wait days or weeks for a primary care appointment.…”

Section: Introductionmentioning

confidence: 99%

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The Affordability of Providing Sexually Transmitted Disease Services at a Safety-net Clinic

Dean

Montgomery

Raifman

et al. 2018

American Journal of Preventive Medicine

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Introduction Sexually transmitted diseases continue to increase in the U.S. There is a growing need for financially viable models to ensure the longevity of safety-net sexually transmitted disease clinics, which provide testing and treatment to high-risk populations. This micro-costing analysis estimated the number of visits required to balance cost and revenue of a sexually transmitted disease clinic in a Medicaid expansion state. Methods In 2017, actual and projected cost and revenues were estimated from the Rhode Island sexually transmitted disease clinic in 2015. Projected revenues for a hypothetical clinic offering a standard set of sexually transmitted disease services were based on Medicaid, private (“commercial”) insurance, and institutional (“list price”) reimbursement rates. The number of visits needed to cover clinic costs at each rate was assessed. Results Total operating cost for 2,153 clinic visits was estimated at $255,769, or $119 per visit. Laboratory testing and salaries each accounted for 44% of operating costs, medications for treatment 7%, and supplies 5%; 28% of visits used insurance. For a standard clinic offering a basic set of sexually transmitted disease services to break even, a projected 73% of visits need to be covered at the Medicaid rate, 38% at private rate, or 11% at institutional rate. Conclusions Sexually transmitted disease clinics may be financially viable when a majority of visits are billed at a Medicaid rate; however, mixed private/public models may be needed if not all visits are billed. In this manner, sexually transmitted disease clinics can be solvent even if not all visits are billed to insurance, thus ensuring access to uninsured or underinsured patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Affordability of Providing Sexually Transmitted Disease Services at a Safety-net Clinic

Dean

Montgomery

Raifman

et al. 2018

American Journal of Preventive Medicine

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“…These populations are at increased risk of STIs and less likely to have established sources of primary care. 6–9 …”

Section: Discussionmentioning

confidence: 99%

“…6,9,11 In 2015, approximately 50% of patients receiving services at the Baltimore City STD clinic were insured, primarily through Medicaid. STD clinics are preferred because of convenience, confidentiality, and cultural competence in treating vulnerable populations.…”

Section: Discussionmentioning

confidence: 99%

Continued Importance of Sexually Transmitted Disease Clinics in the Era of the Affordable Care Act

Mehtani

Schumacher

Johnsen

et al. 2016

American Journal of Preventive Medicine

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Introduction Following the 2014 expansions of Medicaid and private health insurance through the Affordable Care Act, municipal sexually transmitted disease (STD) clinics— which have historically served predominantly uninsured patients—have been threatened with budget cuts nationwide. This study was conducted to evaluate the impact of the insurance expansions on the demand for STD clinic services. Methods The proportion of total incident sexually transmitted infections in Baltimore City that were diagnosed at STD clinics was compared between 2013 and 2014, and a multivariate analysis was conducted to determine factors associated with diagnosis at an STD clinic. Analyses were conducted in July 2015. Results There was no change in the overall proportion of sexually transmitted infection diagnoses made at STD clinics from 2013 to 2014 (relative rate, 1.03; 95% CI=0.95, 1.11). Hispanic ethnicity, black race, male sex, and age >24 years were associated with an increased likelihood of STD clinic utilization (p<0.0001). Conclusions Despite the Affordable Care Act's insurance expansion measures, the demand for STD clinics remained stable. These safety net clinics serve patients likely to face barriers accessing traditional health care and their preservation should remain a priority.

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“The right place and the right time”: A qualitative study of the decision‐making process of self‐initiated HIV testing among young adults

Adebayo

Williams

Garcia

2020

Research in Nursing & Health

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Young adults continue to have very low rates of human immunodeficiency virus (HIV) testing, which contribute to transmission, late diagnoses, and poor health outcomes. The access and uptake of HIV testing among young adults can be improved by promoting self‐initiated testing (i.e., testing without the immediate recommendation of a clinician). Little is known, however, about how young adults self‐initiate HIV testing. The purpose of this study was to explore the decision‐making process of young adults who self‐initiated HIV testing. A qualitative descriptive study was conducted with 30 young adults aged 18–24 years. The findings from this study describe how young adults acknowledge their vulnerability to HIV infection and navigate the process of deciding to self‐initiate testing. Some subcategories include Self‐Convincing, Conversation Prompts, and The Right Place and Right Time. Findings from this study are pivotal for subsequent studies to further understand self‐initiated HIV testing among young adults and design targeted interventions that will improve testing uptake.

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Continuing Need for Sexually Transmitted Disease Clinics After the Affordable Care Act

Abstract: Despite access to other health care settings, patients chose STD clinics for sexual health care because of convenient, low-cost, and expert care. Policy Implication. STD clinics play an important role in STD prevention by offering walk-in care to uninsured patients.

Cited by 47 publications

References 19 publications

The Affordability of Providing Sexually Transmitted Disease Services at a Safety-net Clinic

The Affordability of Providing Sexually Transmitted Disease Services at a Safety-net Clinic

Continued Importance of Sexually Transmitted Disease Clinics in the Era of the Affordable Care Act

“The right place and the right time”: A qualitative study of the decision‐making process of self‐initiated HIV testing among young adults

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