Cost control access and quality of care: the impact of IUD revisit norms in Ecuador.

This paper reports on the results of an operations research study to balance the costs quality of care and access to the Centro Medico de Planificacion Familiar (CEMOPLAF) of Quito Ecuador. The study compared the existing norm of four required revisits to CEMOPLAF with two stimulations: 1) a norm of one required revisit with other revisits optional for clients with problems or questions; and 2) an all revisits optional norm which examines cost-control. To determine the most clinically acceptable and cost-effective norm the study modeled detection of medical problems cost savings and increased new client capacity. Client interviews and medical examinations provided information among IUD users revisiting between January 1 and May 31 1991. Overall results illustrate that the quality cost and access in family planning (FP) programs are interrelated. Program decisions necessarily involve trade-offs so that when administrators seek to improve one aspect they must also consider potential impacts on the other two. Motivated by cost and access concerns the study found that changing the norm would result in a small decrease in quality but major cost savings and improvement in access. Some methodological refinements for research on quality costs and access in FP programs are suggested.