Private physicians' provision of contraceptive services

Abstract

Private physicians provide family planning services to the majority of American women. According to data from the National Ambulatory Medical Care Survey, office-based physicians received on average 13.5 million visits annually for contraceptive services during 1990-1992. Private insurance was the expected from of payment for 38% of visits, while managed care covered 22% of visits, and Medicaid or another source of public assistance subsidized 12%; 22% were self-paid and 6% covered by other sources. The majority of patients who received contraceptive services gave a reason other than general family planning or care regarding a specific contraceptive as the primary purpose for their visit, although women covered by a managed care plan or through public funding were the most likely to give general family planning needs as the main reason. Women whose visit was listed as publicly funded were less likely to have a contraceptive prescribed or provided or to obtain a Pap test than were those expected to pay with private insurance.

PIP: An analysis of patient visit information drawn from the 1990, 1991, and 1992 US National Ambulatory Medical Care Surveys raised concerns that a woman's expected source of payment for services may affect the quality of her reproductive health care. These surveys, conducted by the National Center for Health Statistics, collect data from a nationally representative sample of physicians about visits to private office practices. In 1990-92, an average of 13.5 million contraceptive visits per year were made to private physicians; 94% of patients were women. A contraceptive method was prescribed at 66% of these visits. Interestingly, 81% of women and 64% of men cited a reason other than contraceptive care (e.g., physical examination or Pap smear) for the visit. Payment sources were as follows: private insurance, 38%; managed care plans, 22%; self-pay, 22%; and Medicaid and other government programs, 12%. Women whose family planning visits were covered by Medicaid were significantly more likely to be Black and under 25 years of age. The likelihood of obtaining a contraceptive method at a given visit was 33% lower among Medicaid patients than those with private insurance, while that of receiving a Pap test was 61% lower. Only 56% of publicly funded family planning visits resulted in the prescription of a contraceptive method compared with 79% of privately or self-funded visits.