A Universal Health Insurance Mandate Does Not Equate to Universal Coverage for STI Clinic Patients

Background: In 2006, Massachusetts passed legislation mandating universal health insurance; 98% are now insured.  In an unrelated move, state funding for STI clinics ceased in 2009.  One STI clinic remains open to patients regardless of insurance or ability to pay

Objectives: To determine health insurance status and factors that might impact STI transmission.

Methods: Self-administered anonymous survey offered to new patients >18yrs.  in the waiting area of the remaining “free” STI clinic.

Results: January-July 2011, 465(39%) of patients responded(72% men, age 29±9 years, 72% white non-Hispanic, 9% black non-Hispanic, 6% Hispanic/Latino, 13% other).  101/422(24%) of patients reported not having medical insurance; reasons were recent job loss and lost insurance/unable to afford COBRA(33/95; 35%), unemployed and unable to afford(15%), employed but unable to afford(15%), ineligible for state‑subsidized insurance(10%), recent immigration to the US(4%), did not know how to get insurance but would like to do so(6%).  Of insured, 211/321(66%) chose not to use their insurance; reasons were not wanting insurance company(28%) or parent/spouse/significant other(30%) to know, inability to afford co-pay(24%), and perception that insurance would not cover visit(18%).  63/101(62%) without and 176/320(55%) with insurance were symptomatic or were sexual contacts of people with STIs.  38/239(16%) of these high risk patients needing prompt care, would not have sought immediate care elsewhere if the STI clinic didn’t exist.  

Conclusions: Despite a universal health insurance mandate, a quarter of patients presenting to Massachusetts’ remaining STI clinic are uninsured.  Of those insured, a minority use insurance for the visit when given the choice; confidentiality is cited as a major concern for approximately half of patients.  In the absence of a “free” STI clinic, some high risk patients would delay or defer care. 

Implications for Programs, Policy, and Research: A universal health insurance mandate does not equate to universal coverage or use by STI clinic patients.  Elimination of publicly funded STI clinics may adversely affect infection transmission rates.