239021 Paying for Exercise after Getting it for Free: Impact of a membership fee on YMCA usage by low-income patients

Tuesday, November 1, 2011

Suzanne Cashman, ScD , Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA
Lucy Candib, MD , Family Medicine and Community Health, University of Massachusetts Medical School, Family Health Center, Worcester, MA
Matthew Silva, PharmD , School of Pharmacy - Worcester, Massachusetts College of Pharmacy and Health Sciences, Worcester, MA
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.

Learning Areas:
Administer health education strategies, interventions and programs
Administration, management, leadership
Advocacy for health and health education
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs

Learning Objectives:
1. Be able to describe the opportunities for partnership between community based organizations as a way of increasing access to physical activity for vulnerable populations. 2. Be able to explain the rationale for and cost of developing such partnerships. 3. Be able to discuss the difference in usage of the local YMCA by patient demographic pre and post institution of a monthly fee.

Keywords: Vulnerable Populations, Partnerships

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have contributed to planning, implementing, and evaluating this program.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.