Tuesday, April 3, 2012

Female Condom Distribution in Washington DC

The chair of the Department of Health Behavior and Society at the Johns Hopkins Bloomberg School of Public Health was a coauthor on a recent study that was featured in an article in the Washington Post.  The program that was funded consisted of the distribution of female condoms and a program to encourage women to feel comfortable talking about sexual health.

This article looks at the number of female condoms that were distributed, assumes the number that were actually used, and projects the number of HIV cases that were prevented.  Then, it used an assumption about the lifetime cost of HIV infection ($367,314) and projected the total savings associated with the program.  The lifetime savings were much greater than the cost of buying the female condoms, distributing them, and running the program to encourage women to feel more comfortable about discussing sexual health.

The analysis seems reasonable.  It is important to consider a few things for the economic implications of the study and what else we might expect to see in the long-run.

(1) Will the cost of female condoms change in the future?  Probably.  Of course there is general price inflation, but the key question is whether the relative price will change.  In general, the cost of items at a specific level of quality generally go down over time.

(2) Will the cost of managing HIV over a lifetime change?  Again, probably.  Here we must consider the combination of general price inflation versus relative inflation and the many changes that occur in the price of pharmaceutical products over time.

(3) Will the distribution of who is paying the medical care costs change over time?  This is rather unpredictable until the court case focusing on the Affordable Care Act is decided.

(4) Does the distribution of who is paying the medical care costs matter?  It probably does.  It was nice to have funds to obtain the female condoms to distribute for free.  However, will this continue?  If it does not is there any way to get those who will benefit from female condom use to pay for the condoms to distribute?  Who benefits?  The women--suggesting that a free market decision might work, although obviously we wouldn't need free distribution if the free market solution already worked.  Insurers--they benefit later.  A local public health department would not benefit as it does not pay for most (or perhaps any) of the care.

(5) Does the distribution of female condoms change people's sexual behavior other than getting at least some of them to use the female condoms?  Some worry that when individuals feel safer in having sex, those individuals will have sex more often with more partners.  Is this true? Perhaps, but not necessarily.

(6) Would simply trying to encourage people to avoid non-monogamous sex work?  Then, there would not be the cost of the condoms themselves and, for those who use the approach successfully, there is no failure.  There is, of course, a risk of failing to stick with it.  Whatever we as individuals may think of non-monogamous sex, evidence suggests this doesn't work.

So, would anything likely change the favorable economic outcome suggested by this analysis?  Probably not enough to change the conclusion that distribution of female condoms seems to save a lot of money at the societal level.  The key, politically, would seem to be to find a way to make sure that there is some way for those being asked to pay for the distribution to benefit from the savings.  


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