Providers of reproductive health services, including clinics and office-based physicians, face new challenges as the American health system progresses toward managed care. Although services for low-income women are often subsidized, the average out-of-pocket payments for reproductive health services are the same for women with incomes below and above 200% of the poverty level. Although many women, especially those classified as low income, use clinics, most say that they would prefer to receive care in a private physician's office and in a place where they can get general health care as well. Multivariate analyses indicate the importance of type of insurance and source of primary health care in affecting a woman's selection of her reproductive health care provider. Specialized providers such as family planning clinics need to consider how they can blend with managed care plans.
PIP: To answer questions about women's experiences with reproductive health care in the US, the 1993 Follow-up of the National Survey of Women was used. Telephone interviews were conducted between February 1 and April 15, 1993. The follow-up rate of those interviewed in 1991 was 65%. Interviews were completed with 1093 women 21-40 years old. In 1993, 80% of women interviewed reported that they had received at least one reproductive health service in the previous year. The most common service received was a gynecologic examination, received by 72% of women interviewed. A third of these women also reported receiving contraceptive services. More than 76% of women reported receiving reproductive care from private physicians, while 15% went to clinics, 7% went to health maintenance organizations (HMOs), and 2% went to other types of health providers. Poor women were much more likely to use clinics and more affluent women to use private physicians. 24% reported that their health insurance covered the full cost of care, and 39% reported that their insurance paid some of the cost for care. Medicaid covered the cost of the visit for 7%, and an additional 7% reported that they had received free care. Women overwhelmingly said that they would prefer to receive birth control and other reproductive health services from private physicians. Only 4% reported that they would prefer HMOs, and 8% said they would prefer clinics. 70% preferred a place that provides general health care, although a substantial minority (28%) preferred a place that provides reproductive health care in addition to birth control. In general, the most important factor affecting where a woman receives her reproductive health services is where she receives her regular primary medical care. The growing trend toward managed care will probably continue to shape women's reproductive health choices. Physicians or clinics that do not or cannot join managed care plans are likely to have diminished access to patients.