Preparing for the Changing Landscape of STD Clinics

Background:  The Denver Metro Health Clinic (DMHC) is the largest STD clinic in the Rocky Mountain region with over 20,000 visits yearly.   In anticipation of decreased federal funding and the roll-out of the Affordable Care Act, we initiated several operational adjustments to prepare for the changing environment. These changes included the introduction of Medicaid and third-party billing, and the development of a sliding scale co-pay structure.  To inform these changes, we surveyed patients utilizing our clinic.

Methods:  Between October and November 2013, we assessed all clients presenting for a new visit to gauge client insurance status, reasons for not having insurance, reasons for choosing care at the STD clinic, and types of other healthcare services utilized.

Results:  Of 560 respondents, 325 (58%) were male, 241 (43%) identified as white, non-Hispanic, 168 (30%) as Hispanic, and 112 (20%) as black, non-Hispanic.  The mean age was 39.5 years.  Reasons for choosing the DMHC for care included: confidential visits (42%), how quickly they can be seen (28%) and not knowing where else to go for care (28%).  A total of 250 (46%) clients indicated they had been seen for STD care within the past 12 months with the most frequented venues being the DMHC (36%), Private Physicians (18%), and Planned Parenthood (15%). 365 (65%) of those completing the survey indicated they were not enrolled in health insurance, with 256 (70%) of the uninsured identifying cost as the main reason.  Of the 183(33%) clients who had insurance coverage, 117 (64%) were enrolled in private insurance, 45 (25%) in Medicaid, and 10 (5%) in Medicare. 

Conclusions:  While we plan for expanded health insurance coverage, health insurance alone cannot address access barriers specific to seeking STD related care. Our findings underscore the importance of understanding what drives clients to seek care at STD clinics.