title: Insurance among patients seeking care at a municipal sexually transmitted disease clinic: implications for health care reform in the United States.
abstract: BACKGROUND
  Limited data exist on insured patients who receive care at publically funded sexually transmitted disease (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.
  
  
  METHODS
  We analyzed San Francisco City Clinic patients between August 1, 2011, and December 31, 2012. Insurance was self-reported and included both private and public insurance. Variables from the clinic electronic medical record were examined and included basic demographic and risk behavior questions, as well as positivity among patients tested for chlamydial and gonoccocal infection. We compared the characteristics of insured and uninsured patients using χ test.
  
  
  RESULTS
  There were 13,104 patients in this analysis, of whom 4981 (38%) were categorized as insured and 8123 (62%) as uninsured. Overall, insured patients were older, more likely to be male, more likely to be white, and less likely to be Hispanic compared with uninsured patients (all P < 0.05). In addition, insured patients were more likely to be among men who have sex with men and among HIV-infected individuals compared with uninsured patients (all P < 0.0001). Insured patients were less likely to have a diagnosis of chlamydia at any site or a diagnosis of rectal gonorrhea.
  
  
  CONCLUSIONS
  In our municipal STD clinic, more than one-third of patients report currently having insurance, yet still choose to seek care at the STD clinic. The different characteristics between insured and uninsured patients may reflect reasons other than affordability; therefore, STD clinics remain an important source of care for at-risk populations. These data suggest that the expansion of access to insurance may not result in a reduced need for categorical STD services. Maintaining access to high-quality sexual health services should remain a priority in the era of expanded health care access.
authors.affiliation: From the *STD Prevention & Control Services, San Francisco Department of Public Health, San Francisco, CA, and †Division of Epidemiology, Berkeley School of Public Health, University of California, Berkeley, CA.
authors.forename: Sally C
authors.initials: SC
authors.lastname: Stephens
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Cohen
authors.forename: Susan S
authors.initials: SS
authors.lastname: Philip
authors.forename: Kyle T
authors.initials: KT
authors.lastname: Bernstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D018166:Health Care Reform; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012309:Risk-Taking; D012495:San Francisco / Q000453:epidemiology; D012725:Sexual Behavior; D013587:Syphilis / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D014481:United States