Hospitals aren't a Substitute for Abortion Clinics. Urgent Care Can Be.

In the wake of the Dobbs decision, hospitals increasingly began advertising abortion services to the general public. Prior to the overturning of Roe, most hospitals offered abortion services to patients with later gestational ages or medical complications, focusing on patients that needed specialized treatment rather than serving as a front line access point. However, it is unclear if hospitals are operating as a functional alternative to traditional abortion clinics, or if other solutions are needed. A new study, published in the latest issue of the journal Contraception, suggests that hospitals may not be filling the need created by the loss of traditional abortion clinics, emphasizing the need for novel solutions like primary care and urgent care provision of abortion services.

Researchers investigated the administrative and financial burdens associated with accessing abortion services at hospital facilities. They called 48 hospitals that advertised abortion services, posing as patients at six weeks gestation seeking an abortion. Callers inquired about the type of abortion services available, the next available appointment, and if there were any in-person consultations required before the abortion itself. Callers also documented the number of times their calls were transferred, the minutes spent on hold, the type of payment options available to patients (self-pay or insurance), the costs, and if detailed patient information was required to schedule an appointment.

Of the 48 hospitals called, 10 hospitals required callers to leave a message and four never got back to the researchers, leaving a total number of 44 hospitals. Significant barriers in information gathering were reported:

• 41% (18) required callers to make more than one phone call to speak with an employee

• 14% (5) required more than one transfer to schedule an appointment

• 36% (16) kept callers on hold for more than 2 minutes; with the average hold time being 12 minutes and the maximum 85 minutes

• 34% (15) would not provide information on the next available appointment without collecting detailed patient information to start a chart

Overall only 25% (12) met the study’s classification of a low-barrier calling experience, “defined as providing appointment information during the first call, with no more than one transfer, no more than two minutes of hold time, and no requirement to establish a patient chart”.

Hospitals also performed poorly to non-hospital facilities on both appointment availability and cost:

• 52% of hospitals had an appointment within one week, compared to 72% of non hospital facilities;

• The median wait time at hospitals was 4 week days compared to a wait of 2 week days at non-hospitals;

• The majority of hospital sites did accept self-pay, but only 48% of them offered transparent information on cost;

• Out of pocket costs at hospitals were significantly higher and less transparent than those at nonhospital facilities.

Overall, the researchers found that the administrative complexity and bureaucratic nature of hospital systems forces patients to go through more barriers than they would at a non-hospital facility. This is an important finding due to the time sensitive nature of abortions- delays can limit eligibility for medication, raising costs and the risk of complications, and increased costs can be insurmountable barriers to obtaining care. These findings are particularly important in areas where clinics may have closed forcing patients to rely on hospital systems for abortion care.

This study demonstrated the importance of expanding abortion access through non-hospital facilities, including urgent care centers. FemInEM has been working on urgent care provision of medication abortion for over a year now. Our partnership with Marquette Medical Urgent Care, has led to over one hundred patients being able to obtain medication abortion services in the wake of a clinic closure. Further, the FemInEM Medication Abortion in Urgent Care Toolkit is meant to scale this model, giving other urgent cares the resources to increase access to low-barrier abortion care. We will continue to scale this work, and disseminate this work nationally because evidence shows that this is what our patients need.