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Background: It is unclear whether the need for public STD clinics as safety net providers will persist after the Affordable Care Act (ACA). We evaluated the change in routine access to health care among STI clinic patients one year after ACA implementation.
Methods: We surveyed persons attending five categorical Chicago STI clinics in 2013 (prior to ACA implementation) and one year later. The survey assessed socio-demographic characteristics, insurance status, and access to health care. We present adjusted prevalence rate ratios (PRR) for factors associated with routine access to healthcare identified using multivariable Poisson regression.
Results: Among 754 participants in 2013 and 964 in 2014, 60% were men, median age was 27 years, and 84% were non-white. Patients who had routine access to health care (both preventive and sick) increased by 4% from 37% in 2013 to 41% in 2014 (P = 0.01). Compared to uninsured patients, insured patients were 87% more likely to have routine access to healthcare (PRR: 1.87; 95% CI 1.62-2.15). Other factors associated with increased routine access to healthcare were older age (>45 years) (PRR: 1.64; 95% CI: 1.36-1.98) when compared to age group 14-25. Heterosexual men and MSM were 36% (PRR: 0.64; 95% CI: 0.55-0.74) and 20% less likely (PRR: 0.80; 95% CI: 0.66-0.97) to have routine access to healthcare when compared to women. Other variables associated with decreased access to health care were being unemployed (PRR: 0.82 95 % CI: 0.69-0.98) and not having a high school degree (PRR: 0.66; 95 % CI: 0.51-0.85) when compared to fully employed and college educated patients, respectively.
Conclusions: There has been a significant increase in routine access to health care among STI clinic patients one year after ACA implementation. However, disparities in access to health care still persist especially among those at highest risk of acquisition of STIs.