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P3.058 Utilization of Municipal STD Clinic Services Among the Insured, San Francisco 2011–2: Implications For Health Care Reform in the United States

Limited data exist on the number of insured patients who receive care at publically funded STD clinics, despite having access to a primary care provider. In this analysis, we compare patients with and without health insurance who sought services at City Clinic, the San Francisco municipal STD clinic. We analysed San Francisco City Clinic visits between August 1, 2011 and August 31, 2012. Insurance was self-reported at registration and included both private and public insurance. Variables from the clinic electronic medical record were examined and included basic demographic and risk behaviour questions, as well as positivity among asymptomatic patients tested for vaginal, urethral, rectal, pharyngeal and/or rectal chlamydial and gonoccocal infection. We compared the characteristics of insured and uninsured patients using chi-square statistics. There were 18,232 patient visits in this analysis, of which 6,305 (35%) were categorised as insured and 11,927 (65%) as uninsured. Overall, insured patients were older, more likely to be male, more likely to be white, and less likely to be Hispanic compared to uninsured patients (all p < 0.05). Additionally, insured patients were more likely to be men who have sex with men, and more likely to be HIV-infected compared to uninsured patients (all p < 0.0001). Among asymptomatic patient visits, insured patients were less likely to have a diagnosis of chlamydia at any site or a diagnosis of rectal gonorrhoea. In our municipal STD clinic, over one-third of patients currently report having insurance, yet still choose to seek care at the STD clinic. These data suggest that the expansion of access to insurance may not result in a reduced need for categorical STD services. Confidentiality and cost may be reasons for continued use of STD clinics among the insured. Maintaining access to high quality sexual health services should remain a priority in the era of expanded health care access.