The Costs and Benefits of IUD Follow - Up Visits In the Mexican Social Security Institute

Volume 25, Number 1, March 1999 and providers (in terms of draining overall resources and interfering with scheduling appointments for clients with medical needs). Consequently, regimens of frequent revisits should afford a clear and demonstrated health benefit before they are accepted as standard medical practice. Research on IUD follow-up visits has been limited in scope and methodology. A reanalysis of clinical trial data found little medical benefit of routine follow-up visits.5 However, the analysts relied on information drawn from case report forms and a secondhand medical interpretation of the clinic visit; in addition, they did not estimate the costs of the visits and compare them with the possible health benefits. In Ecuador, researchers interviewed returning IUD users to estimate (indirectly) the programmatic implications of different revisit norms; they found that reducing the number of follow-up visits would result in a small decrease in the number of problems detected, but also would lead to major cost savings and improvements in access to services.6 The study we describe in this article improves on previous efforts by using an experimental design to compare the medical benefit with the cost of routine follow-up care for IUD users obtaining services at the Mexican Social Security Institute (IMSS), Mexico’s largest health care provider.7 David Hubacher is senior research associate and Barbara Janowitz is director of health services research, Family Health International (FHI), Research Triangle Park, NC, USA. Carmen Cárdenas and Daniel Hernández are consultants, Mexican Academy for Medical and Demographic Research, Mexico City. Manuel Cortés is medical researcher, Instituto Mexicano del Seguro Social, Mexico City. Support for this study was provided by FHI with funds from U.S. Agency for International Development (USAID) cooperative agreement CCP-A-00-95-00022-02. The views expressed in this article do not necessarily reflect those of FHI or USAID. Helpful comments on earlier versions were provided by Cynthia Waszak and Judith Fortney. The Costs and Benefits of IUD Follow-Up Visits In the Mexican Social Security Institute