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  • Title: An economic interpretation of the distribution and organization of abortion services.
    Author: Kay BJ, Whitted NA, Hardin SS.
    Journal: Inquiry; 1981; 18(4):322-31. PubMed ID: 6460698.
    Abstract:
    Compared with other medical services, elective abortion is a special case where economic factors affecting delivery remain essentially constant. The consumer purchases it infrequently and the provider provides relatively frequently; the patient is not seeking information or interpretation of symptoms, only therapeutic service for which the technique is almost universal. In this area of medicine the consumer assesses the symptoms and decides on treatment before selecting a provider. U.S. women are not using abortion as a means of contraception in general and if they do, it is only once or twice. Prices charged for 1st trimester abortions are relatively stable ($171 in 1978, $174 in 1980). Since the liberalization of abortion legislation in 1973 there has been a yearly increase in elective 1st trimester abortions (85%), but a decreasing rate for each subsequent year (21% for 1973-74, 4% for 1977-78). Unmet need decreased from 58% in 1973 to 26% in 1978, concentrated in rural areas. The supply of abortions is subjected to constraints such as the aura of illegality, negative professional peer pressure, and distribution of providers. In 1977 13% of all providers performed 71% of all abortions, freestanding clinics had an average case load of more than 1600 year, hospitals provided 3% of abortions and office-based physicians performed 4%. In contrast to other medical services, abortion is a cash-on-delivery transaction with only 10% of patients submitting insurance forms. Information is provided to consumers regarding cost and quality of services through advertising and professional referral and is relatively widely available due to efforts of women's organizations, evaluative information is also disseminated. In Atlanta, 7 clinics performed 20,337 procedures in 1977, an increase of 1859 from 1976, prices ranging from $125-$165 in 1978 with a coefficient of variation of 0.09, the same since 1972-73. In a survey of 75 university students who had had abortions (16.8% of those who returned a questionnaire distributed at the university), it was found that newspaper and word of mouth are initial information sources about providers. Most important factors in choosing a provider were medical reputation, time required, absence of need for parental consent, and staff attitude. If present trends in delivery of services continue as demand levels off, large freestanding clinics will grow and choices will decrease. Statewide dissemination of information about facilities, particularly to people with access problems, would assist the consumer to increase competition between large and small clinics. 1 option for further research is the comparison of abortion services in different locations with varying market structure and degree of unmet need.
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