Private Physicians' Provision of Contraceptive Services.

Private physicians provide family planning services to the majority of American women. According to data from the National Ambulatory Medical Care Survey office-based physicians received on average 13.5 million visits annually for contraceptive services during 1990-1992. Private insurance was the expected form of payment for 38% of visits, while managed care covered 22% of visits, and Medicaid or another source of public assistance subsidized 12%; 22% were self-paid and 6% covered by other sources. The majority of patients who received contraceptive services gave a reason other than general family planning or care regarding a specific contraceptive as the primary purpose for their visit, although women covered by a managed care plan or through public funding were the most likely to give general family planning needs as the main reason. Women whose visit was listed as publicly funded were less likely to have a contraceptive prescribed or provided or to obtain a Pap test than were those expected to pay with pri vate insurance.

(Family Planning Perspectives 28:203-209, 1996)

Among all women who made a medical visit for family planning from 1987 to 1988, a majority (64%) went to a private physician, while 36% attended a family planning clinic. (1) Although there has been extensive research on publicly funded family planning clinics and the services that they provide, (2) few studies of family planning care have focused on private physicians.

A survey of private office-based physicians in 1983 found that 100% of obstetrician-gynecologists and 84% of general and family practitioners provided reversible contraceptives to their patients. In addition, 94% of obstetrician-gynecologists, 18% of general and family practitioners and 89% of urologists performed sterilization procedures. (3)

In the early 1980s, obstetrician-gynecologists accounted for one-third of the private physicians offering reversible contraceptive services. However, these providers saw, on average, four times as many contraceptive patients as did general and family practitioners; thus, they served more than two thirds of all patients visiting private physicians for reversible contraception. (4)

Surveys of low-income women show that although most would prefer to go to private physicians for their contraceptive care, financial constraints typically compel them to obtain such care at publicly supported family planning clinics. (5) In fact, during the 1980s, the percentage of low income women (those below 150% of poverty) who made their most recent family planning visit to a private physician declined from 52% in 1982 to 40% in 1988, while the percentage of women with an income at or above 150% of poverty who visited a private physician for family planning remained fairly stable (at approximately 75%) over the same period. (6)

Medicaid, the federal-state entitlement program that covers medical care for welfare recipients and low-income pregnant women, theoretically affords patients access to both public and private family planning providers. However, Medicaid enrollees may not be able to find a private physician who will serve them. Among obstetrician-gynecologists and general and family practitioners in 1983 who offered contraceptive services, only 56% accepted Medicaid. (7) Similarly, in 1987, only 54% of obstetrician-gynecologists served patients on Medicaid, (8) and in 1990-1993, only two-thirds of all physicians in independent or small group practices participated in Medicaid. (9)