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Family Planning
|
FY
2007 Actual |
FY
2008
Enacted |
FY
2009
Estimate |
FY
2009 +/-
FY 2008 |
BA |
$283,146,000
|
$299,981,000 |
$299,981,000
|
---
|
|
42 |
42 |
45
|
+3 |
Authorizing
Legislation: Title X of the Public Health Service
Act
FY
2009 Authorization |
Expired |
Allocation
Method |
Competitive
Grant |
Program Description and Accomplishments
The Title X Family Planning program was enacted in
1970 as Title X of the Public Health Service Act.
Title X is the only federal grant program dedicated
solely to providing individuals with comprehensive
family planning and related preventive health services.
The Title X program is designed to provide access
to contraceptive services, supplies and information
to all who want and need them. By law, priority is
given to persons from low-income families. Title X
service funds are allocated to the ten Public Health
Service (PHS) Regional Offices which, manage the competitive
review process, make grant awards and monitor program
performance. Services are provided through 88 service
delivery grants that support a nationwide network
of more than 4,400 clinics that provide services to
approximately 5,000,000 persons annually. Historically,
90 percent of the clients served each year have incomes
at or below 200 percent of the Federal poverty level.
Family planning service grants are made to public
and private not-for-profit organizations to support
the provision of family planning clinical services
and information.
Services are delivered through a network of community-based
clinics that include State and local health departments,
hospitals, university health centers, independent
clinics, and public and nonprofit agencies. In FY
2003, nearly 75 percent of U.S. counties had at least
one provider of contraceptive services that was funded
by the Title X family planning program. Ninety percent
of the program funds are used to provide clinical
services. For many clients, Title X clinics provide
the only continuing source of health care and/or health
education.
The family planning program provides a broad range
of effective and acceptable family planning methods
and related preventive health services. The Title
X program also supports three key functions aimed
at assisting clinics in responding to clients’
needs: (1) training for family planning clinic personnel
through ten regional general training programs, one
national clinical training program, one national training
center, and one national training program aimed at
enhancing quality services for males in Title X projects;
(2) information dissemination and community-based
education and outreach activities; and (3) data collection
and research to improve the delivery of family planning
services.
The Title X Family Planning program addresses HHS
Strategic Goal 3, “Increase the percentage of
the Nation’s children and adults who have access
to health care services, and expand consumer choice,”
and supports the Secretary’s “500-Day
Plan” by supporting community-based approaches
to close the health care gap.
In 2006, the most recent data available, just over
975,000 unintended pregnancies were averted,
1.35 million screenings for Chlamydia infection in
15 – 24 year old females and 799 cases of invasive
cervical cancer were prevented through the services
provided by the Title X Program. All of these accomplishments
were below their initial targets, mainly as a result
of the increase in medical care prices for services,
contraceptives and other medical supplies and diagnostic
tests.
The Program under went its PART review in the Spring
of 2005 and received a rating of Moderately Effective.
The PART noted that the Program’s overall purpose,
design and management are strong; that the clients
who use Title X clinics receive better care than women
who utilize private physicians or HMOs; and despite
the collection of annual data, the Program lacked
performance goals for some of its key program activities.
As a result, the Program developed performance targets
and goals for all of its main program activities and
has planned and begun an independent evaluation of
sufficient quality and scope which will examine and
demonstrate the overall impact of the program.
Funding History
FY
2004 |
$278,283,000 |
FY
2005 |
$285,963,000 |
FY
2006 |
$282,907,000
|
FY
2007 |
$283,146,000
|
FY
2008 |
$299,981,000 |
Budget Request
The FY 2009 Budget Request is $299,991,000, which
is equal to the FY 2008 funding amount. The request
provides funding for family planning methods and related
preventive health services, as well as related training,
information and education, and research to improve
family planning service delivery.
The program will continue to seek ways to increase
efficiencies in order to maintain services despite
the increasing costs of pharmaceuticals, providers,
and screening and diagnostic technologies with the
goal of maintaining the actual cost per client below
the medical care inflation rate. In addition, the
program will continue to seek ways to increase competition
for family planning service funds, targeting areas
that currently lack access to family planning services.
The FY 2009 funding level is expected to support family
planning services for approximately 4,985,000 persons,
with at least 90 percent of clients having incomes
at or below 200 percent of the federal poverty level.
In addition, it is forecasted that around 978,000
unintended pregnancies will be averted, 1.349 million
screenings for Chlamydia infection in 15 – 24
year old females and 798 cases of invasive cervical
cancer be prevented in FY 2009 through the services
provided throughout the Title X Program. These services
include the provision of family planning methods,
education, counseling and related preventive health
services. The annual targets for FY 2008 and FY 2009
reflect the increase and subsequent level amount of
funding. Although the program will continue to emphasize
being as efficient as possible, rising costs of medical
care will make it difficult to maintain service delivery
at FY 2008 levels. The revised targets for both FY
2008 and FY 2009 still represent aggressive figures
based on the significant increases in medical costs,
the current program’s appropriation, grantee
revenue from other sources and forecasted trends for
the future.
Despite the rise in medical care costs, the family
planning program has been able to maintain the average
cost per Title X clients below the medical rate of
inflation, although the program has observed a slight
decrease in the number of overall clients served.
To address this decrease, the program’s main
strategy in FY 2007 was to increase clinic efficiency
through a concentrated training effort. The Office
of Family Planning (OFP) identified and provided to
each of the ten Regional Training Centers (RTCs) funding
to address a National Training Priority area: providing
training to Title X providers on improving clinic
efficiency in an effort to address increasing costs
of health care without sacrificing quality. This concerted
training effort and the development of region-specific
plans to address clinic efficiency, quality assurance/continuous
quality improvement, appropriate staffing patterns
and purchasing strategies, various methods of cost
analyses and other areas were aimed at developing
processes to more effectively address client needs
and mitigate the effects of medical cost increases.
The OFP continues to emphasize the need for clinic
efficiency and to support provide technical assistance
to improve clinic management, cost reduction strategies
and more efficient resource allocation.
Additionally, the OFP has awarded a 1% evaluation
task order entitled, “An Analysis of the Effectiveness
of Title X Family Planning Providers’ Use of
the 340B Drug Pricing Program.” The purpose
of this evaluation is to document the successes, challenges/obstacles
and trends of Title X providers’ use of the
340B Drug Pricing Program. Better insight into this
and other drug pricing programs will help Title X
clinics provide better care to their clients, serve
them more efficiently and lower costs in an effort
to improve health care access and quality and promote
preventive health practices.
#
|
Key
Outcomes a,b |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008 Target |
FY
2009 Target |
Out-year
Target |
Target
|
Actual |
Target
|
Actual
|
Long-Term
Objective: Expand the availability of healthcare,
particularly to undeserved, vulnerable and special
populations. |
36.II .A.1 |
Increase the total number of
unduplicated clients served in Title X clinics
by 5% over five years. |
5,067,785 |
5,002,961 |
5,162,000 |
4,992,498 |
5,162,000 |
Jul-08 |
5,000,000 |
4,985,000 |
2010:
4,975,000 |
36.II .A.2 |
Maintain the proportion of clients
served who are at or below 200% of the Federal
poverty level at 90% of total unduplicated family
planning users. |
91% |
90% |
90% |
90% |
90% |
Jul-08 |
90% |
90% |
2010:
90% |
36.II .A.3 |
Increase the number of unintended
pregnancies averted by providing Title X family
planning services, with priority for services
to low-income individuals. c |
1,125,300 |
978,845
d |
1,142,608 |
975,080 |
1,012,655 |
Jul-08 |
981,000 |
978,000 |
2010:
976,000 |
Long-Term
Objective: Increase the utilization of preventive
health care and chronic disease management services,
particularly among underserved, vulnerable, and
special needs populations. |
36.II .B.1 |
Reduce infertility among women
attending Title X family planning clinics by identifying
Chlamydia infection through screening of females
ages 15-24. e |
Not
Collected |
1,349,884 |
1,398,000 |
1,353,319 |
1,398,000 |
Jul-08 |
1,352,000 |
1,349,000 |
2010:
1,347,000 |
#
|
Key Outcomes
a,b |
FY 2004 Actual
|
FY 2005 Actual
|
FY 2006 |
FY 2007 |
FY 2008 Target
|
FY 2009 Target
|
Out-year
Target |
Target |
Actual |
Target |
Actual |
36.II .C.1 |
Increase the number of unduplicated
female clients who receive a Pap test. f |
Not
Collected |
2,447,498 |
2,450,000 |
2,324,488 |
2,450,000 |
Jul-08 |
2,372,000 |
2,365,000 |
2010:
2,361,000 |
36.II .C.2 |
Reduce invasive cervical cancer
among women attending Title X family planning
clinics by providing Pap tests. g |
Not
Collected |
808 |
809 |
799 |
809 |
Jul-08 |
800 |
798 |
2010:
796 |
#
|
Key
Outputs |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008 Target |
FY
2009 Target |
Out-year
Target |
Target
|
Actual |
Target
|
Actual
|
Efficiency
Measure |
36,E |
Maintain the actual cost per
Title X client below the medical car inflation
rate. h i |
$193.92 |
$200.81 |
$223.97 |
$215.56 |
$233.73 |
July-08 |
$243,92 |
$254.55 |
2010:
$265.64 |
|
Appropriated Amount ($ Million) |
278.283 |
285.963 |
|
282.907 |
|
283.146 |
299.981 |
299.981 |
|
Notes:
a |
Data
Source for the performance table: Family Planning
Annual Report (FPAR). The FPAR consists of 14
tables in which grantees report data on user demographic
characteristics, user social and economic characteristics,
primary contraceptive use, utilization of family
planning and related health services, utilization
of health personnel, and the composition of project
revenues. Table 4 collects information on the
unduplicated number of family planning users by
income level. |
b
|
Data
Validation: The responsibility for the collection
and tabulation of annual service data from Title
X grantees rests with the Office of Population
Affairs (OPA), which is responsible for the administration
of the program. Reports are submitted annually
on a calendar year basis (January 1 - December
31) to the regional offices. Grantee reports are
tabulated and an annual report is prepared summarizing
the regional and national data. The annual report
describes the methodology used both in collection
and tabulation of grantee reports, as well as
the definitions provided by OPA to the grantees
for use in completing data requests. Also included
in the report are lengthy notes that provide detailed
information regarding any discrepancies between
the OPA requested data and what individual grantees
were able to provide. Data inconsistencies are
first identified by the Regional Office and then
submitted back to the grantee for correction.
Additionally, discrepancies found by the contractor
compiling the FPAR data submits these to the Office
of Family Planning (OFP) FPAR data coordinator
who works with the Regional Office to make corrections.
All data inconsistencies and their resolution
are noted in an appendix to the report. These
are included for two reasons: (1) to explain how
adjustments were made to the data, and how discrepancies
affect the analysis and (2) to identify the problems
grantees have in collecting and reporting data,
in hope of improving the process.
|
c |
Using population-based data from the National
Survey of Family Growth (NSFG), contraceptive
use, and contraceptive method failure rates to
estimate the rate of pregnancies averted, it is
calculated that pregnancies averted are 20.65%
of the number of women who receive publicly funded
family planning services. This multiplier factor
was changed for 2005 based on updated data from
NSFG. This percentage is applied to the total
number of females served in Title X clinics (FPAR)
to arrive at the number of pregnancies averted
as a result of the Title X program. Increasing
the number of clients is contingent on increased
efficiency within the Title X service delivery
system, and will be addressed through technical
assistance and training. |
d
|
2005 Actual data represents the first year that
the described updated multiplier is being used.
|
e |
Based
on changes from CDC based on the positivity rate
for Chlamydia in Title X clinics, targets and
results may be adjusted accordingly. |
f
|
The
baseline was determined using data from the 2005
FPAR. |
g
|
The
baseline was determined by applying the formula
for determining the projected cases of invasive
cervical cancer to the 2005 FPAR Data using the
# of unduplicated female users who received a
Pap test. Methodology – The range in number
of cases of invasive cervical cancer prevented
will be estimated using accepted estimates of
the number of cases of invasive cervical cancer
that would result if women were screened annually
and if they were screened every three years (33
cases per 100,000 women screened in an annual
Pap test and 96 cases per 100,000 women screened
every three years). |
h |
Data
Source: Consumer Price Indexes of Medical Care
(CPI)/U.S. Department of Commerce, Bureau of Labor
Statistics |
i |
Targets
for FY 06, 07 and 08 are based on forecasted CPI.
The targets are determined as a product of the
baseline figure (1999 actual cost per client)
and the corresponding year’s CPI for medical
care prices. The target for future years is determined
as a product of the prior year’s target
and the forecasted CPI for the year based on historical
data. The targets will be recalculated to reflect
the actual CPI once the data are available. The
measure allows the Program to quantify the efficiency
of the services while controlling for the cost
of medical care using the consumer price index
(CPI). As a result, preventive services and related
reproductive health outcomes can be assessed with
respect to cost per client compared to the CPI
of Medical Care. |
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