December 30, 2000 New York Times
http://www.nytimes.com/2000/12/30/science/30ABOR.html?ex=1236916800&en=00d96c9ce90c0983&ei=5070
The focus of this article is the competition for patients between the dwindling number of independent abortion providers. To the abortion provider, the more patients they have, the more income they make. Wait, I thought the abortion rights movement was about women's rights and wellbeing, not makinig a profit? Hmm....
As Abortion Rate Decreases, Clinics Compete for Patients
By GINA KOLATA
DETROIT — Renee Chelian was worried about her business. With competitors charging lower prices, she needed something special to draw customers. So she created an almost a spa-like atmosphere at her offices, with low light in the rooms, aromatherapy, candles and relaxing music.
Ms. Chelian runs three abortion clinics in the Detroit suburbs, where competition is so fierce that each clinic owner is looking for an edge.
In Detroit, and in other large metropolitan areas around the country, there are not too few abortion providers, as abortion proponents have lamented for years. There are too many. It is still true that fewer hospitals are providing abortions, fewer doctors outside abortion clinics are offering the procedure and 86 percent of counties in the country have no abortion provider.
But, over the past few years, as the number of abortions has declined, abortions increasingly have been concentrated in specialty clinics in cities and pockets of competition have developed.
So while women in rural areas must sometimes drive hundreds of miles to the nearest clinic, in cities and suburbs there are price wars and competition over amenities. Doctors have refused to train colleagues, fearing they will only help a potential competitor in a lucrative, often cash-only, business.
National statistics compiled by the Alan Guttmacher Institute illustrate the clinics' problem. The number of abortions declined by 17.4 percent in just seven years, to a low of 1.328 million in 1997 from a peak of 1.608 million abortions in 1990, the most recent year for which statistics are available.
Different groups give different explanations for the drop. The National Right to Life Committee credits the persuasive power of abortion opponents as well as laws requiring informed consent and parental notification. But Dr. Stanley Henshaw, a senior fellow at the Guttmacher Institute who analyzed abortion data, said the reason is mostly better birth control. While it is true, he said, that more teenagers are keeping their babies, most of those having abortions are in their early 20's and fewer of them are becoming pregnant.
Whatever the reason, the falling number of abortions has come at a time when the number of clinics in major cities has not changed. Since 1992, the number of clinics doing 400 or more abortions a year has remained steady at 690. It is in these clinics — 99 percent of which are in metropolitan areas — that 89 percent of abortions take place.
The Cost of Competition
Clinic owners say they have little choice but to cluster in cities — that is the only way they can find enough patients. Ruth Arick, the owner of Choice Pursuits in DeLand, Fla., which does management consulting for abortion clinics, said that a population of about 200,000 is needed to support a full-fledged clinic.
Abortion clinics are not so different from other specialty services, said Dr. William Ramos, who runs an abortion clinic in Las Vegas.
"In the entire state of Nevada, there is only one Lexus dealer and only one Acura dealer," he said.
But, abortion providers say, unlike other areas of medicine, where prices have surged over the years, competition among abortion clinics has kept prices so low that an abortion in many cities costs less now than it did 25 years ago, without even adjusting for the nearly 500 percent inflation in medical services. If abortion had kept up with inflation in medical services, a $300 abortion in 1972 would cost $2,251 today.
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