The communicable disease impact of eliminating publicly funded prenatal care for undocumented immigrants.
OBJECTIVE
In 1996, California proposed regulations to eliminate publicly funded prenatal care for undocumented immigrants. Prenatal treatment of sexually transmitted infections (STIs) can prevent STI-related adverse outcomes of pregnancy (AOP). The study assessed the STI-related health and economic impact of the proposed regulations in Los Angeles County (LAC).


METHODS
We modeled excess STI-related AOPs and associated costs that would occur in LAC as if the regulations were implemented in 1995. Using attributable fractions in the exposed for five STIs and their associated AOPs, we calculated excess STI-related AOPs and their costs that would result from the regulations and the degree to which excess morbidity would offset gross savings.


RESULTS
The model indicates that, depending on regulatory level, 74, 110, or 132 excess AOPs would occur subsequent to the regulations, representing lost prevented morbidity. These excess AOPs would cost $5.1, $7.6, or $9.2 million dollars in direct medical expenses, offsetting anticipated savings by 19.2%, 29.0%, or 34.9%. This analysis does not include other costs of these STIs or costs associated with non-STI-related sequelae of diminished prenatal care, all of which could further offset anticipated savings.


CONCLUSIONS
The proposed regulations would likely lead to increased STI-related morbidity and costs, thereby offsetting anticipated savings. Health departments are in a special position to promptly respond to policy issues affecting vulnerable populations. The development of a practical and rational framework for local-level policy assessment can be important for encouraging good scientific approaches that respond to calls for reductions in basic preventive health services.
Kuiper
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Los Angeles County Department of Health Services Sexually Transmitted Disease Program, Los Angeles, California 90007, USA.
Richwald
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GA
Rotblatt
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Asch
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D002140:California / Q000453:epidemiology; D004641:Emigration and Immigration / Q000331:legislation & jurisprudence*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000191:economics / Q000517:prevention & control / Q000706:statistics & numerical data; D008403:Mass Screening; D008484:Medicaid / Q000331:legislation & jurisprudence*; D018803:Models, Economic; D008962:Models, Theoretical; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000191:economics*; D015995:Prevalence; D012749:Sexually Transmitted Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology