Family Planning Activities Under Title X of the Public Health Service Act

In fiscal year 1980, the Department of Health and Human Services (HHS) spent about $375 million for family planning services and contraceptive supplies through several different programs. About $156 million of these funds went to about 5000 clinics serving about 3.8 million persons. From a study of 26 clinics, GAO concluded that family planning clinics can provide quality care more efficiently and that clinics could raise more revenue from clients if consistent fee policies were followed. Present program guidelines recommend too many revisits for women using oral contraceptives, education that does not appear to be needed by all clients, and some routine medical tests that do not appear to be necessary for all clients. These practices unnecessarily add to program cost, and they may contribute to long waits for appointments and long office visits, which may deter participation by some or discourage some clients from continuing in the program. Although some clinics have successfully used sliding fee scales to charge clients who had the ability to pay, other family planning projects have made little or no effort to generate fee income. Some clinics charged no one, while others charged even low-income clients who should have received free service. One clinic was making fee payment a condition of service. Conflicts have been caused by using title X and title XX social services funds for the same programs. Some States have elected to provide free family planning serices under their title XX programs regardless of client income. Other States have adopted income standards for eligibility that differ from those specified in HHS title X program regulations. Congress should consider consolidating Federal funding for family planning programs to include family planning funds under the title X and title XX programs and the Maternal and Child Health Program. In the interim, HHS needs to consider how best to resolve the difference between the title X and title XX programs regarding eligibility for free or subsidized service.