The Marion County Health and Human Services headquarters in Salem (Rachel Alexander/Salem Reporter)
Marion County residents won’t be able to get birth control or pregnancy tests from the county health department any longer.
The move is part of shifting the focus of public health away from direct service as expansions in Medicaid and a state law expanding access to uninsured patients have led to fewer people seeking care from Marion County Health and Human Services.
The clinic on 3180 Center St. N.E. and the Woodburn clinic will no longer offer family planning services like birth control prescriptions as the number of patients seeking those visits has dropped by more than 75% in the last decade.
DOCUMENT LINK: Equitable Access to Public Health Services Assessment Report
County spokeswoman Jenna Wyatt said the department is shifting focus to connecting patients with private health providers. In 2017, Oregon passed the Reproductive Health Equity Act which reimburses enrolled providers for care they give people without insurance. People who previously didn’t qualify for the Oregon Health Plan because of their immigration status or income can receive care under the act.
“That act itself shifts the need for public health to do that direct service,” Wyatt said.
Now when a person calls in looking for a provider, the health department has a list of clinics in the area that are enrolled in the reproductive health program or that offer sliding scale payments, she said.
County staff included in the assessment skepticism their clients could find care elsewhere. One noted the role the clinic plays in prescribing long-acting reversible contraception like implants and intrauterine devices, which are highly effective at preventing pregnancy over several years but have high upfront costs.
"We support a lot of the community clinics with [long-acting reversable contraception]. Clients can get in quickly … and that is very important to preventing unplanned pregnancies,” the staff member said.
Marion County Public Health Administrator Katrina Rothenberger said the providers interviewed for the assessment report had adequate capacity to meet the area’s needs.
“Due to the low utilization of these services at Marion County, providers in our community will be able to continue to meet the community's needs. We will continually assess the data and will work to fill any gaps should they arise,” she said in an email.
Wyatt said the move will be a benefit to patients who will be able to establish a relationship with a primary care provider.
“I think it’s really a positive,” she said.
Over the past decade, the clinic has seen a 80% decline in visits for family planning services from a high of about 7,500 visits in 2012 to about 1,300 in 2019. That period coincides with the expansion of Oregon Health Plan, which allowed many adults who previously lacked coverage to get insurance.
The number of patients saw a similar drop. In 2012, there were 3,510 patients that visited the clinic for family planning. Last year there were 686.
There's also been a significant decline in demand for the clinics’ other preventative health programs: sexually transmitted disease screening and treatment, immunizations and tuberculosis treatment.
A decade ago, 4,701 patients visited the clinic for immunizations, while only 1,307 visited the clinic for shots last year.
The clinic hasn’t been open since March but is planning for slow re-opening by appointment only. The clinic will continue offering STD testing, tuberculosis treatment and immunization.
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