A statewide program established in 1997 to expand access to comprehensive family planning services for low income California residents has helped decrease the number of unintended pregnancies in the state, according to a report released by the University of California, San Francisco and the California Department of Health Services (DHS). The DHS provided this report, the first evaluation results for the California Family PACT (Planning, Access, Care and Treatment) program, to the legislature today, July 20, 2000.
"Family PACT has significantly reduced the number of unintended pregnancies among low-income women in California," said Claire Brindis, Dr.PH, author of the report and professor in the UCSF Department of Pediatrics. She also is co-director at the UCSF Center for Reproductive Health Research and Policy, which is under the auspices of the UCSF Institute for Health Policy Studies and Department of Obstetrics, Gynecology and Reproductive Sciences. "Contraceptive services provided during the first year prevented more than 100,000 unintended pregnancies that would have resulted in 50,000 unintended births, 41,000 induced abortions, 15,000 miscarriages and 1,400 ectopic pregnancies."
"Family PACT services also saved over $512 million in public expenditures for medical care, income support and social services for mothers and children that otherwise would have been incurred as a result of unintended pregnancies," Brindis said. The program spent $114 million for services provided during the first year.
During the first full fiscal year of the Family PACT program, 749,572 clients were served. This is a 43 percent increase over the number served during the prior fiscal year through the state's previous family planning program. From its inception in 1997 through June 1999, Family PACT served more than 1.5 million clients.
The Family PACT program includes education and counseling for clients, informed consent, confidentiality, provision of a full range of options, linguistic and cultural competence, timely access to care and provision of clinical and preventive services.
"In addition to fiscal impact, the evaluation also addressed quality of care," said Philip Darney, MD, report author and UCSF professor of obstetrics, gynecology and reproductive sciences. Darney also co directs the UCSF Center for Reproductive Health Research & Policy. "This evaluation indicates that implementation of the Family PACT program was achieved without compromising the quality of care established in the previous state program."
Innovative features of the Family PACT program were designed to increase access to services for women and men who have no other source of care and have a family income below 200 percent of the Federal Poverty Level. Eligibility is determined and clients are enrolled "on site" by their medical care provider. Providers include community clinics, family planning clinics, health departments and private practice clinicians. Practitioners who are currently authorized to provide services through the Medi-Cal program are eligible to become Family PACT providers after attending a daylong orientation. Reimbursement for services to Family PACT clients is similar to that for Medi-Cal services. The program also provides reimbursement to pharmacies for over-the-counter products and prescription drugs needed for services covered by the program.
"Family PACT has gained national attention as an innovative public health program," said State Health Director Diana M. Bontá, RN, Dr.PH. "DHS and community health care providers have accomplished many positive results and the success of this program is evident in the evaluation results." Family planning and related reproductive health services provided by the program include medical care, education, counseling, medications, supplies and laboratory services related to periodic reproductive health screening, contraceptive methods, basic infertility services, cervical cancer screening, sexually transmitted infection (STI) diagnosis and treatment and HIV screening. "The program has been a valuable resource in state efforts to control STIs. During the first year of the program, approximately 750,000 STI and HIV tests were provided to program clients," Darney said.
"Both the number and the type of providers have expanded with the implementation of Family PACT," Darney said. "The previous state family planning program included 142 agencies with 450 clinical sites. By the end of its first year, Family PACT included 2,172 providers and more than 2,650 providers had joined the program as of June 1999."
The evaluation report was based on analyses carried out by the UCSF Evaluation Team and on the work of the DHS STD Control Branch, the California Family Health Council, the Center for Health Training, Berkeley Economic Research Associates, The Pacific Health Consulting Group, the Public Health Institute and Electronic Data Systems. Evaluation methods included observation of client services, interviews of clients and providers, chart reviews and analysis of service and billing data.
The UCSF Center for Reproductive Health Research and Policy and the UCSF Institute for Health Policy Studies prepared the report.