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Background: Uninsured persons are a primary population using publicly-funded safety net sexually transmitted disease (STD) prevention services. The percentage uninsured of the US population is expected to decrease over the next 10 years, but will remain above 10%. Understanding the size of the uninsured risk population who are a priority for STD prevention, as well as the potential costs of meeting some of their needs, would help anticipate the demand for such services.
Methods: We defined the risk population who should be prioritized for STD services as sexually-active women aged 15–24 years, pregnant women, women 25–44 years or men 15–44 years with multiple sex partners (past year), and men who had ≥1 male sex partners (past year). We estimated the size of the risk population and insurance status using the National Survey of Family Growth. To estimate the proportion of the non-elderly population without insurance in each year 2013–2023, we used Congressional Budget Office estimates and Census data to account for population growth. We estimated a lower bound cost of providing potential services to this priority uninsured risk population by calculating the costs of chlamydia screening and treatment to the uninsured risk population based on cost estimates from the literature and chlamydia positivity data from the National Health and Nutrition Examination Survey (2012 US dollars).
Results: The uninsured risk population equaled 7.8 million persons in 2013, falling to 4.4 million by 2023. The annual cost of providing chlamydia services to this population would be $239.7 million in 2013, declining to $135.0 million in 2023.
Conclusions: Although decreases are expected, a substantial need will continue to exist for safety net STD prevention services over the next 10 years. The cost of chlamydia screening and treatment indicates the financial burden of providing services to the uninsured STD priority population is substantial.