Public Savings from the Prevention of Unintended Pregnancy: A Cost Analysis of Family Planning Services in California

Abstract

Objective. To assess the short-term economic savings associated with the prevention of unintended pregnancies through California's Medicaid family planning demonstration project. Data Sources. Secondary data from health and social service programs available to pregnant or parenting women at or below 200 percent of the federal poverty level in California in 2002 and data on the quantity and type of contraceptives dispensed to clients of California's 1115 Federal Medicaid demonstration project. Study Design. The cost of providing publicly funded family planning services was compared with an estimate of public savings resulting from the prevention of unintended pregnancies. Data Collection. To estimate costs and participation rates in each health and social service program, we examined published program reports, government budgetary data, analyses conducted by federal and state level program managers, and calculations from national datasets. Findings. The unintended pregnancies averted by California's family planning demonstration project in 2002 would have incurred $1.1 billion in public expenditures within 2 years and $2.2 billion within 5 years, significantly more than the $403.8 million spent on the project. Each dollar spent generated savings of $2.76 within 2 years and $5.33 within 5 years. Conclusions. The California 1115 Medicaid family planning demonstration project resulted in significant public cost savings. The cost of the project was substantially less than the public sector health and social service costs which would have occurred in its absence.

The impact of publicly-financed family planning services on pregnancies, births, and costs: A critical review of the peer-reviewed literature

“…Of the eleven studies reviewed, five were conducted as state-specific analyses [7][8][9][10][11] , four as cross-state comparisons 12-15 and two examined aggregated national-level data 16,17 .…”

“…Another study reported on improvements in birth outcomes in response to publicly financed family planning care, citing a reduced number of low-birth weight births, births with late or no prenatal care, infant deaths and neonatal dates 14 . The most commonly reported measure across reviewed studies was unintended pregnancies averted [7][8][9][10]16,17 . When taken together, results from these state and national-level analyses suggest that publicly funded family planning services avert a significant proportion of unintended pregnancies.…”

“…Two of these studies provided national-level estimates 16,17 , while the third calculated state-level costsavings from California's Family PACT programme 7 . Each study approached cost calculations differently.…”

“…Of the eleven studies reviewed, three calculated the public-sector cost savings associated with publicly financed family planning care 7,16,17 . Two of these studies provided national-level estimates 16,17 , while the third calculated state-level costsavings from California's Family PACT programme 7 .…”

“…Of these eleven studies, six relied on within-subject analysis [7][8][9][10]16,17 while five integrated the use of separate exposure and comparison groups [11][12][13][14][15] , capitalising on the staggered implementation of publicly subsidised family planning programmes among states and the natural division of treatment and control groups formed through income-eligibility cut-offs. Of the five multi-group analyses, two employed a time series approach 14,15 and three relied on a cross-sectional, difference-in-difference design [11][12][13] .…”