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Trends in clinic visits and diagnosed Chlamydia trachomatis and Neisseria
gonorrhoeae infections after the introduction of a copayment in a
sexually transmitted infection clinic.
Sexually Transmitted Diseases 2005;32(4):243-246.
Rietmeijer CA, Alfonsi GA, Douglas JM, Lloyd LV, Richardson DB, Judson
FN.
Abstract
BACKGROUND: To meet their sexually transmitted infection (STI) control mission,
STI clinics most often offer services at no or minimal cost to clients. However,
there is little knowledge about the effects of charging service fees on clinic
attendance and STI identification. As a result of budget shortfalls, a clinic
fee of 15 US dollars for Denver residents (up to 65 US dollars for nonresidents)
was introduced in the Denver Metro Health (STI) Clinic (DMHC) in December
2002. We evaluated the effects of the fee on clinic utilization and diagnosed
Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infections. METHODS:
Using the DMHC computerized medical record system, we compared clinic visits
and CT/GC diagnoses between the first 3 quarters of 2002 and 2003. We also
compared CT/GC cases reported by DMHC with those reported by other Denver
providers during 2002 and 2003. RESULTS: Compared with 2002, there were 3250
fewer visits (-28.5%) to DMHC in 2003 with no variance across quarters. CT
diagnoses declined by 427 cases (-28.1%), disproportionately affecting women
(-40%) and those under 20 (-42%). In addition, there were 332 fewer GC diagnoses
(-38.1%) with no clear demographic preponderance. Although there were some
decreases in non-DMHC CT/GC reports, the ratio of DMHC to non-DMHC reports
declined from 0.42 to 0.33 (-21.4%) for CT and from 0.94 to 0.61 (-35.1%)
for GC. CONCLUSIONS: Even a modest fee for service appears to have a major
impact on the use of STI clinic services and may result in a significant
effect on the ability to diagnose CT/GC infections, especially among those
at highest risk.