Drainoni Mari-Lynn, Sullivan Meg, Sequeira Shwetha, Bacic Janine, Hsu Katherine
From the *Department of Health Policy and Management, Boston University School of Public Health, Boston, MA; †Section of Infectious Diseases, Boston University School of Medicine, Boston, MA; ‡Center for Health Quality, Outcomes & Economic Research, ENRM Veterans Administration Hospital, Bedford, MA; §Section of General Internal Medicine, Boston University School of Medicine, Boston, MA; ¶Division of STD Prevention & HIV/AIDS Surveillance, Massachusetts Department of Public Health, Jamaica Plain, MA; and ∥Section of Pediatric Infectious Diseases, Boston University School of Medicine, Boston, MA.
Sex Transm Dis. 2014 Jul;41(7):455-60. doi: 10.1097/OLQ.0000000000000135.
In the Affordable Care Act era, no-cost-to-patient publicly funded sexually transmitted infection (STI) clinics have been challenged as the standard STI care delivery model. This study examined the impact of removing public funding and instituting a flat fee within an STI clinic under state-mandated insurance coverage.
Cross-sectional database analysis examined changes in visit volumes, demographics, and payer mix for 4 locations in Massachusetts' largest safety net hospital (STI clinic, primary care [PC], emergency department [ED], obstetrics/gynecology [OB/GYN] for 3 periods: early health reform implementation, reform fully implemented but public STI clinic funding retained, termination of public funding and institution of a US$75 fee in STI clinic for those not using insurance).
Sexually transmitted infection visits decreased 20% in STI clinic (P < 0.001), increased 107% in PC (P < 0.001), slightly decreased in ED, and did not change in OB/GYN. The only large demographic shift observed was in the sex of PC patients--women comprised 51% of PC patients seen for STI care in the first time period, but rose sharply to 70% in the third time period (P < 0.0001). After termination of public funding, 50% of STI clinic patients paid flat fee, 35% used public insurance, and 15% used private insurance.
Mandatory insurance, public funding loss, and institution of a flat STI clinic fee were associated with overall decreases in STI visit volume, with significant STI clinic visit decreases and PC STI visit increases. This may indicate partial shifting of STI services into PC. Half of STI clinic patients chose to pay the flat fee even after reform was fully implemented.
在《平价医疗法案》时代，对患者免费的公共资助性传播感染（STI）诊所作为标准的性传播感染护理提供模式受到了挑战。本研究调查了在州规定的保险覆盖范围内，取消公共资金并在性传播感染诊所实行统一收费的影响。
横断面数据库分析考察了马萨诸塞州最大安全网医院4个科室（性传播感染诊所、初级保健[PC]、急诊科[ED]、妇产科[OB/GYN]）在3个时期的就诊量、人口统计学特征和支付方构成变化：医疗改革初期实施阶段、改革全面实施但公共性传播感染诊所资金保留阶段、公共资金终止且性传播感染诊所对未使用保险者实行75美元收费阶段。
性传播感染诊所的性传播感染就诊量下降了20%（P<0.001），初级保健科室增加了107%（P<0.001），急诊科略有下降，妇产科未变化。观察到的唯一较大的人口统计学变化是初级保健科室患者的性别——在第一个时期，女性占因性传播感染护理就诊的初级保健科室患者的51%，但在第三个时期急剧上升至70%（P<0.0001）。公共资金终止后，50%的性传播感染诊所患者支付统一费用，35%使用公共保险，15%使用私人保险。
强制保险、公共资金损失以及性传播感染诊所统一收费的实行与性传播感染就诊总量的总体下降相关，性传播感染诊所就诊量显著下降，初级保健科室的性传播感染就诊量增加。这可能表明性传播感染服务部分转移到了初级保健科室。即使在改革全面实施后，仍有一半的性传播感染诊所患者选择支付统一费用。
