Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program.
Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program.
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DOI：
10.1111/1468-0009.12080
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发表时间：
2014-12
期刊：
影响因子：
--
通讯作者：
Finer LB
中科院分区：
文献类型：
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作者：
Frost JJ;Sonfield A;Zolna MR;Finer LB
每年，美国政府支持的计划生育项目为数百万低收入妇女提供服务。尽管与该计划服务相关的健康影响和公共部门节省远远超出了预防意外怀孕的范围，但它们从未被完全量化。根据一系列调查数据和公布的参数，我们估计了2010年在公共支持的计划生育环境中提供避孕药具、人类免疫缺陷病毒（HIV）和其他性传播感染（STI）检测、巴氏试验和人类乳头瘤病毒（HPV）检测以及HPV疫苗接种所产生的直接国家级和州级健康效益。我们估计了这些服务节省的公共成本，并将其与2010年公共资助的计划生育服务成本进行比较，以找到公共部门的净节省。我们调整了对计划外生育成本节省的估计，以排除一些不合时宜的生育，这些生育如果发生在以后，将继续由公共资助，并包括5岁以下儿童的医疗费用。2010年，在公共支持的计划生育访问期间提供的护理避免了约220万次意外怀孕，包括287，500次近距离分娩和164，190次早产或低出生体重（LBW）分娩，99，100例衣原体感染，16，240例淋病，410例艾滋病毒感染和13例，170例盆腔炎，可能导致1,130例异位妊娠和2,210例不孕症。子宫颈抹片和人类乳头瘤病毒检查以及人类乳头瘤病毒疫苗接种预防了约3 680例宫颈癌和2 110例宫颈癌死亡;人类乳头瘤病毒疫苗接种还预防了9 000例异常后遗症和癌前病变。由第十条国家计划生育方案支持的保健中心提供的服务占这些福利的一半以上。这些服务节省的公共资金总额约为158亿美元，其中157亿美元用于预防计划外生育，1.23亿美元用于性传播感染/艾滋病毒检测，2300万美元用于巴氏涂片和人乳头瘤病毒检测和疫苗。从总节省额中减去22亿美元的项目成本，公共部门净节省136亿美元。美国计划生育项目的公共支出不仅防止了意外怀孕，而且降低了早产和低出生体重儿、性传播感染、不孕症和宫颈癌的发生率和影响。这项投资为政府节省了数十亿美元的公共资金，相当于每花费一美元就为纳税人节省了7.09美元。
Each year the United States’ publicly supported family planning program serves millions of low-income women. Although the health impact and public-sector savings associated with this program's services extend well beyond preventing unintended pregnancy, they never have been fully quantified. Drawing on an array of survey data and published parameters, we estimated the direct national-level and state-level health benefits that accrued from providing contraceptives, tests for the human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), Pap tests and tests for human papillomavirus (HPV), and HPV vaccinations at publicly supported family planning settings in 2010. We estimated the public cost savings attributable to these services and compared those with the cost of publicly funded family planning services in 2010 to find the net public-sector savings. We adjusted our estimates of the cost savings for unplanned births to exclude some mistimed births that would remain publicly funded if they had occurred later and to include the medical costs for births through age 5 of the child. In 2010, care provided during publicly supported family planning visits averted an estimated 2.2 million unintended pregnancies, including 287,500 closely spaced and 164,190 preterm or low birth weight (LBW) births, 99,100 cases of chlamydia, 16,240 cases of gonorrhea, 410 cases of HIV, and 13,170 cases of pelvic inflammatory disease that would have led to 1,130 ectopic pregnancies and 2,210 cases of infertility. Pap and HPV tests and HPV vaccinations prevented an estimated 3,680 cases of cervical cancer and 2,110 cervical cancer deaths; HPV vaccination also prevented 9,000 cases of abnormal sequelae and precancerous lesions. Services provided at health centers supported by the Title X national family planning program accounted for more than half of these benefits. The gross public savings attributed to these services totaled approximately $15.8 billion—$15.7 billion from preventing unplanned births, $123 million from STI/HIV testing, and $23 million from Pap and HPV testing and vaccines. Subtracting $2.2 billion in program costs from gross savings resulted in net public-sector savings of $13.6 billion. Public expenditures for the US family planning program not only prevented unintended pregnancies but also reduced the incidence and impact of preterm and LBW births, STIs, infertility, and cervical cancer. This investment saved the government billions of public dollars, equivalent to an estimated taxpayer savings of $7.09 for every public dollar spent.