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FAMILY
PLANNING
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Key
Outcomesa,b |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008
Target |
FY
2009
Target |
Out-year
Estimate |
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 |
July-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% |
July-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 |
July-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 |
July-08 |
1,352,000 |
1,349,000 |
2010:
1,347,000 |
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 |
July-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 |
July-08 |
800 |
798 |
2010:
796 |
# |
Key Outcomes |
FY 2004
Actual |
FY 2005
Actual |
FY 2006 |
FY 2007 |
FY 2008
Target |
FY 2009
Target |
Out-Year
Estimate |
Target |
Actual |
Target |
Actual |
Efficiency
Measure |
36.E |
Maintain
the actual cost per Title X client below the
medical care 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) |
$278.3 |
$286.0 |
|
$282.9 |
|
$283.1 |
$300.0 |
$300.0 |
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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. a
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.
d2005 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.
INTRODUCTION
The Program currently has five performance measures
that focus on increasing access and serving individuals
and families from underserved, vulnerable and low-income
populations, three gauging the extent to which the
Program expands the availability of healthcare to
the public and two measuring the limit to which preventive
health care and chronic disease management services
are utilized. Each of the performance measures and
the efficiency measure, guide the Program’s strategy,
establish direction for technical assistance and direct
revisions in program policies. This enables the Program
to better address program performance and facilitate
methods to increase efficiency in the delivery of
preventive healthcare services. The Program’s major
challenge to meeting its targets and maintaining a
high-level of service delivery is the continued increase
in medical care prices, which ultimately results in
a decrease in clients served. The Program’s main
strategy to address this issue continues to be employing
the use of focused training efforts, directing training
funding and identifying National Training Priorities
to address quality assurance, staffing patterns, procurement
strategies and other areas related to improved clinic
management, cost reduction and resource allocation.
DISCUSSION OF RESULTS AND TARGETS
36.II.A.1. Increase the total number of unduplicated
clients served in Title X clinics by 5% over five
years. (Indicator: Total number of unduplicated
clients served.)
In 2006, the most recent year for which Program
data are available, 4.992 million unduplicated clients
were served at 4,442 Title X clinics. This represents
a decrease of slightly less than a quarter percent
in the number of clients served in 2006 over the number
served in 2005. Of these, 95 percent were women and
5 percent were men. The small decrease (1.49%) in
overall users between 2004 and 2006 suggests a continuing
leveling off trend in client numbers, following the
more substantial gain experienced between 2000 - 2001
when additional funds were provided to the Program.
The decrease is also a reflection of the continued
increase in the cost of medical supplies and cost
for services, including the rising cost of contraceptive
supplies. The FY 09 target is 4,985,000 unduplicated
clients.
36.II.A.2. Maintain the proportion of clients
served who are at or below 200 percent of the Federal
poverty level at 90% of total unduplicated family
planning users.
(Indicator: The proportion of clients with incomes
at or below 200 percent of the Federal poverty level.)
Title X Family Planning clinics play a key role
in providing family planning and related preventive
health services to individuals who can least afford
such services - low-income persons, many of whom have
no insurance or lack insurance coverage for family
planning and related preventive health care services.
The Title X program provides family planning education
and services to all persons who desire them and assures
access by giving priority to low-income persons.
The Program consistently maintains the proportion
of clients who are at or below 200% of the Federal
poverty level at 90% of the total unduplicated number
of family planning clients. In 2006 and historically,
of the total number of unduplicated clients, 90 percent
had incomes at or below 200 percent of the Federal
poverty level. The Target for FY 09 is 90%.
36.II.A.3. Increase the total number of unintended
pregnancies averted by providing Title X Family Planning
Services, with priority for services to low-income
individuals.
(Indicator: Total number of unduplicated female
clients served in Title X clinics multiplied by a
factor of 20.65%; prior to the 2005 data the factor
was 23.3%)
Each year, publicly-subsidized family planning services
assist women in avoiding an estimated 1.3 million
unintended pregnancies. Title X is a major provider
of publicly funded family planning services and offers
a broad range of contraceptive methods and services,
which enables men and women to plan pregnancies and
space births, important elements in ensuring positive
birth outcomes and a healthy start for children and
families. In FY 06, 975,080 unintended pregnancies
were averted through the provision of family planning
and related preventive health services in Title X
clinics. The FY 06 figure is less than the FY 05
actual and the FY 06 target largely due to the change
in the multiplier used to determine this figure as
well as a decrease in female users. The initial FY
05 and 06 targets were established using the original
multiplier which was higher than the most current
multiplier. (See section below on “Targets Substantially
Exceeded or Not Met.”) The FY 09 target is 978,000
unintended pregnancies averted.
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.
(Indicator: The number of female clients ages 15-24
who received a Chlamydia test.)
Title X, through the provision of family planning
and related preventive health services, has an impact
in preventing infertility in women and ensuring their
health, well-being and ability to have a healthy pregnancy.
Based on Chlamydia prevalence data collected by the
CDC Division of STD Prevention under the Infertility
Prevention Program (IPP), the number of infertility
cases prevented can be calculated. IPP data collected
over several years illustrates that there is a 5.9
percent positivity rate for Chlamydia in family planning
clinics. If left untreated, an estimated 10 - 40
percent of those cases would lead to pelvic inflammatory
disease (PID). Of those, an estimated 20 percent
would become infertile due to the untreated infection.
This calculation results in an estimated number of
cases of infertility.
In FY 05, the baseline as well as future targets
were established regarding the number of females ages
15 - 24 years screened for Chlamydia. In FY 06, 1,353,000
screenings for Chlamydia were conducted. While the
number of screenings in FY 06 was more than in FY
05, the targets for FY 06 were not met. The decrease
in the number of female clients is the primary reason
for this occurrence. The target for FY 09 is 1,349,000.
36.II.C.1. Increase the number of unduplicated
female clients who receive a Pap test.
(Indicator: Number of unduplicated female clients
who receive a Pap test.)
Title X funded agencies are required to perform
Pap tests according to nationally recognized standards
of care, to document these results in the client’s
record and to have a system to track or monitor follow-up
care for abnormal results. The frequency of Pap testing
varies based on individual circumstances, but current
recommendations stipulate screening every one to three
years. Beginning in 2005, data was collected on the
number of unduplicated clients receiving a Pap test
in order to better understand and monitor the scope
of cervical cancer screening in Title X projects.
In FY 06, 2,324,488 unduplicated women received a
Pap test, about 5% lower than the previous year.
The decrease in the number of female clients as well
as less frequent screening in accordance with current
medical standards are the primary reasons for this
occurrence. The target for FY 09 is 2,365,000.
36.II.C.2. Reduce invasive cervical cancer among
women attending Title X family planning clinics by
providing Pap tests.
(Indicator: The projected cases of invasive cervical
cancer avoided based on the number of unduplicated
female users in Title X who received a Pap test.)
Based on Title X clinics providing Pap tests for
their female clients and using accepted estimates
of the number of cases of invasive cervical cancer
that would result if screening did not occur (33 cases
per 100,000 women screened annually and 96 cases per
100,000 women screened every three years), the number
of invasive cervical cancer cases prevented can be
calculated. In FY 05, the FPAR began collecting data
on the unduplicated number of women receiving Pap
test in Title X projects. Using this figure, the
range of invasive cancer cases prevented by Pap testing
in Title X clinics can be calculated.
In FY 06, at least 799 cases of invasive cervical
cancer were prevented as a result of the number of
women who attended and received a Pap test at a Title
X clinic, slightly lower than the number of cases
prevented in FY 05. The target for FY 09 is 798.
1.E Maintain the actual cost per Title X family
planning client below the medical care inflation rate.
(Indicator: The actual cost per client is derived
by dividing the total revenue by the total number
of individuals served, and then factoring in the annual
medical care Consumer Price Index (CPI).)
It is vital that family planning clinics maximize
the number of patients served. Tracking the average
cost per client, and factoring the medical care price
index, is an appropriate process to assess efficiency.
The program is able to measure and set targets for
the average cost per client using the FPAR data and
comparing the annual rate of growth of actual expenditures
to the baseline amount forecasted using the CPI for
medical care prices.
In 2006 the actual cost per client was $215.56,
$8.41 less than the targeted projection. This resulted
in cost avoidance of approximately $42 million in
client costs. The Program has consistently met or
come under the annual target for this measure and
historically has kept its increase in total cost per
client below that of the CPI for medical care costs.
The Target for FY 09 is $254.55.
TARGETS SUBSTANTIALLY EXCEEDED OR NOT MET
Measure: Increase the number of unintended pregnancies
averted by providing Title X family planning services,
with priority for services to low-income individuals.
FY 06 target: 1,142,608
FY 06 result: 975,080
The performance result was substantially lower than
the target for FY 06. This outcome was primarily
due to the change in the multiplier used to determine
the number of unintended pregnancies averted through
the Title X Family Planning Program. The initial
targets were developed using the original multiplier,
approximately 11% higher than the current figure,
thus establishing an inflated target figure. In addition,
the decrease in the unduplicated number of female
clients seen contributed to the target not being met,
but to a much lesser degree. The out-year targets
have been adjusted downward to reflect the change
in multiplier and the forecast in unduplicated clients.
The crisis of unintended pregnancy continues to
exist, despite advances in preventive health care
practice and medical advances. The Program’s mission
to continue to provide education and preventive health
care services, especially to the underserved, vulnerable,
low-income and others who are disproportionately affected,
is essential given the continued decline in preventive
health indicators and widening of health-related disparities.
The performance measure is an effective indicator
of the Program’s effectiveness and reflects a positive
health outcome for the mission of and the preventive
health services performed by the Program.
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