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Provision of STD Services in Community Settings After the Loss and Return of State Funding to Support Service Provision

Observations From Select Providers in Massachusetts, 2010 and 2013

Loosier, Penny S. PhD, MPH; Carter, Marion W. PhD; Hsu, Katherine K. MD; Doshi, Sonal MS, MPH; Peterson Maddox, Brandy L. MPH; Kroeger, Karen PhD; Cranston, Kevin MDiv

Journal of Public Health Management and Practice: November 28, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHH.0000000000000887
Research Full Report: PDF Only

Context: In 2008, the $1.2 M sexually transmitted disease (STD) services line item supporting STD clinical services by the Massachusetts Department of Public Health was eliminated, forcing the cessation of all state-supported STD service delivery.

Objective: To determine the impact on community provision of STD services after the elimination of state funds supporting STD service provision.

Design and Setting: Rapid ethnographic assessments were conducted in May 2010 and September 2013 to better understand the impact of budget cuts on STD services in Massachusetts. The rapid ethnographic assessment teams identified key informants through Massachusetts's STD and human immunodeficiency virus programs.

Participants: Fifty providers/clinic administrators in 19 sites (15 unique) participated in a semistructured interview (community health centers [n = 10; 53%], hospitals [n = 4; 21%], and other clinical settings [n = 5; 26%]).

Results: Results clustered under 3 themes: financial stability of agencies/clinics, the role insurance played in the provision of STD care, and perceived clinic capacity to offer appropriate STD services. Clinics faced hard choices about whether to provide care to patients or refer elsewhere patients who were unable or unwilling to use insurance. Clinics that decided to see patients regardless of ability to pay often found themselves absorbing costs that were then passed along to their parent agency; the difficulty and financial strain incurred by a clinic's parent agency by providing STD services without support by state grant dollars emerged as a primary concern. Meeting patient demand with staff with appropriate training and expertise remained a concern.

Conclusions: Provision of public health by private health care providers may increase concern among some community provision sites about the sustainability of service provision absent external funds, either from the state or from the third-party billing. Resource constraints may be felt across clinic operations. Provision of public health in the for-profit health system involves close consideration of resources, including those: leveraged, used to provide uncompensated care, or available for collection through third-party billing.

Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Loosier, Carter, and Kroeger and Mss Doshi and Peterson Maddox); and Massachusetts Department of Public Health, Boston, Massachusetts (Dr Hsu and Mr Cranston).

Correspondence: Penny S. Loosier, PhD, MPH, Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS US 12-2, Atlanta, GA 30329 (

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

The authors declare no conflicts of interest.

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