Paying for Exercise after Getting it for Free: Impact of a membership fee on YMCA usage by low-income patients

Introduction Through a partnership between a federally qualified community health center and a local YMCA, open access was offered to health center patients at no cost to them. After 12 months, partnership parameters changed. Patients now would have to pay $10/month for any month that they used the facility. We tracked and analyzed usage by demographic characteristics to determine the fee's impact. Methods Natural experiment with a pre/post design. Participants were all adult health center patients who used the YMCA before and after institution of the fee. Data were collected through sign-in sheets prior to instituting the fee (12 months) and through swipe card post fee (12 months). Outcome measure is visits/user/month. Participant demographic data include: age, gender, ethnicity, usage, insurance. Univariate and bivariate analyses were conducted. Results After instituting the fee, 80% of users stopped going. There was a significant difference by age (pre-fee users were older p<.018) and ethnicity (pre-fee users were more likely to be Latino , p=.01) but none by gender. Pre-fee users were also likely to be lighter users (as determined by active months p<.0001). Patients who used the YMCA both before and after institution of the fee had a higher average visit/month after institution of the fee. Institution of $10/month co-payment for low-income patients to use the YMCA resulted in lighter using and older patients ending their visits. Losing access for people who could not consistently pay, light and perhaps exploratory users, means we must continue looking for ways to lower barriers for people.