The report offers a series of recommendations to strengthen performance, including investment in clinical quality improvement and value-based purchasing strategies to incentivize greater preventive service capacity. The report also recommends strengthening partnerships between health centers and Title X family planning programs in order to reach the hardest-to-serve populations. The authors underscore the role played by Title X in assuring access to care in medically underserved communities.
"This report breaks new ground in our understanding of health centers' role in family planning," says Susan F. Wood, PhD, lead study author, associate professor of health policy and executive director of the Jacobs Institute of Women's Health at SPHHS. "Our findings underscore the opportunities and challenges in strengthening access to this vital service."
Sara Rosenbaum, JD, Harold and Jane Hirsh Professor of Health Law and Policy at SPHHS and a study co-author, added "This report confirms health centers' contributions to prevention and draws the link between proven value-based purchasing strategies and key preventive services."
Health centers' role in preventive health can be expected to grow as a result of their expansion under the Affordable Care Act. By 2019, health center patients are expected to double. Over half of all health center patients are women of childbearing age.
Julio Bellber, President and CEO of the RCHN Community Health Foundation, stated, "Community health centers play a key role in delivering primary care, and family planning services always have been a core primary care service. Strengthening capacity and performance is essential."
The nationwide health center survey presented in the analysis finds that 87% of all health centers provide what the analysis defines as a "typical" package of family planning methods, defined by the authors as birth control pills plus one other contraceptive method such as condoms, implants, or IUDs, along with sexually transmitted infection screening and treatment. The study also documents wide variation in scope and quality of care and reports that half of all health centers lack the current ability to dispense birth control pills on-site despite their high effectiveness and low cost. Among the report's other key findings:
- Family planning services are more likely to be comprehensive at larger health centers operating in urban/suburban neighborhoods as well as those in Western states.
- Title X participation is the single strongest predictor of health center performance and on-site access to care including counseling and education and an array of contraceptive methods. An estimated 26% of all health centers participate in Title X.
- The most comprehensive health center family planning programs tend to be located in states with more generous Medicaid adult coverage levels as well as policy environments that support women's health.
- Health centers face significant barriers in building the scope and quality of any specific set of services, including family planning, as a result of the extensive community poverty and the competing demands of patients along the full spectrum of age and need. This reality emphasizes the importance of additional sources of access, such as that furnished through independent clinics funded under the Title X program.