1. Hale, Nathan L. PhD
  2. Smith, Michael MSPH
  3. Hardin, James PhD


Objective: The role of local health departments (LHDs) as a clinical service provider remains a salient topic of discussion. As local and state health departments continue to migrate away from clinical services, there is need to understand the impact on these transitions on access to care in a given community. The purpose of this study was to examine the impact of clinical capacity reductions in LHDs on receipt of annual family planning visits among South Carolina women.


Design: A rolling panel of women eligible for Medicaid between 2001 and 2012 was created. Receipt of an annual visit for each year of Medicaid eligibility was tracked over time. A typology reflecting changes in county capacity for clinical services was used as the independent variable. We estimated multivariate generalized estimating equation models, which examined changes in population-averaged probabilities (marginal means) of annual family planning visits over time by level of county typology.


Results: Approximately 325 269 unduplicated women were included in the panel, with 25.18% receiving an annual visit in a given year. On average, receipt of annual visits in counties with notable reductions in LHD clinical capacity tended to be fewer over time (-0.022; 95% CI [confidence interval], -0.028 to -0.017) as among counties with reduced capacity that included a specific clinic closing (-0.032; 95% CI, -0.037 to -0.028). However, the magnitude of observed differences between county typologies was relatively small.


Conclusions: Evidence of service discontinuity was present. However, differences occurred later in the study period following the economic recession. Our findings suggest that counties that reduced capacity did not lose ground but were unable to meet increasing demand from the economic recession relative to those that did not reduce capacity even when closing a clinic. As LHDs discontinue or significantly reduced clinical services, fulfilling the assurance role is important for transitioning women to other sources of care.