A Call to Revisit the Prenatal Period as a Focus for Action Within the Reproductive and Perinatal Care Continuum

Objectives The broad maternal and child health community has witnessed increased attention to the entire continuum of reproductive and perinatal health concerns over the past few years. However, both recent discouraging trends in prenatal care access and utilization and a renewed understanding of prenatal care as a critical anchor of the reproductive/perinatal health continuum for women who do get pregnant demand a new effort to focus on the prenatal period as a gateway for maternal and infant health. Methods This commentary: describes the Medicaid expansions and the momentum for universal access to prenatal care of the 1980–1990s; examines the pivot away from this goal and its aftermath; provides a rationale for why renewed attention to prenatal care and the prenatal period is essential; and, explores the potential focus of an updated prenatal care agenda. Conclusion We conclude that increasing women’s access to high quality prenatal care will require substantial effort at the clinical, community, policy, and system levels. Only when attention is paid to all phases of the reproductive/perinatal health continuum with an emphasis on continuity between all periods, and on the social determinants that affect health and well-being, will our nation be able to ensure the health of all women across the life course (whether or not they ever become mothers), while simultaneously fulfilling our nation’s promise that all children—no matter their income or race/ethnicity—will have the opportunity to be born well.     

Hawaii's health care plan stirs Capitol Hill debate over access.

Even as officials in Hawaii prepare to market to congressional legislators their universal access health care plan as a model for the nation, small-business owners on the mainland are battling against mandates in place in the state's unique health care program. Meanwhile, Hawaiian officials continue to make ongoing improvements in their system.     

Learning from the Aloha State

Since 1974, Hawaii has required its employers to provide health insurance to all employees working at least 20 hours a week. More recently, the state created a new program to cover the "gap group" of 50,000 uninsured residents, along with a new program to create a "seamless system of health care" for all Aloha State residents. And Hawaii has managed to insure nearly all of its citizens while keeping the annual price of health insurance at nearly half of that paid in many mainland states ($1,300 per person and $4,000 per family). At the same time, life expectancy is the highest in the nation and infant mortality is among the lowest. In seeking to reform a dysfunctional national insurance system, policymakers should learn from the Hawaiian experience, which shows that small business can live with an employer mandate, universal coverage can cut costs by encouraging early preventive care, and a dominant payer can reduce administrative expenses.     

Mexican health insurance: uncertain universal coverage

The Mexican health system is comprised of the Department of Health, state labor social security and the private sector. It is undergoing a reform process initiated in 1995 to achieve universal coverage and separate the regulation, financing and service functions; a reform that after fifteen years is incomplete and problematic. The scope of this paper is to assess the problems that underlie the successive reforms. Special emphasis is given to the last reform stage with the introduction of the "Insurance of the People" aimed at the population without labor social security. In the analysis, health reform is seen as part of the Reform of the State in the context of neoliberal reorganization of society. Unlike other Latin American countries, this process did not include a new Constitution. The study is based on official documents and a systematic review of the process of the implementation of the System of Social Health Protection and its impact on coverage and access to health services. The analysis concludes that it is unlikely that universal population coverage will be accomplished much less universal access to services. However, reforms are leading to the commodification of the health system even in the context of a weak private sector.     

新时期我国覆盖全民的医疗保障体系与发展战略

我国的医疗保障制度改革经历了制度框架探索时期、制度构建时期、制度发展时期和逐步走向全民医保时期,现行多层次医保体系和迈向全民医保的制度特征意义逐渐明确。《中共中央、国务院关于深化医药卫生体制改革的意见》和《医药卫生体制改革近期重点实施方案（2009--2011年）》是实现全民医保的行动纲领,将保证全民医保起到解决“看病难”与“看病贵”的屏障和安全网的作用。     

Canadians write a new Rx for healthcare. Canada's healthcare system is not a panacea, but it raises interesting issues for the United States

The Canadians have been impressive in delivering universal healthcare access and high-quality care. Operating under global budgets set by provincial governments, Canadian hospitals have prudently managed available resources to meet community needs. A weakness of this single-payer system, however, is its inability to effectively coordinate and integrate services delivered by hospitals, physicians, and other providers. As the U.S. health system faces stringent cost containment with President Bill Clinton's proposal, significant savings are expected of U.S. hospitals. New alliances constrained by global budgets might require healthcare services managers to operate under a disparate set of assumptions and incentives. Before making such a transition, we can learn from the experiences of our Canadian colleagues. The challenges for both nations in the remaining years of this century will be drawn primarily from the effective macromanagement controls of the Canadian system and the lessons being learned from the U.S. managed care networks. This will occur as each nation strives to provide a more effective, less costly, integrated delivery of healthcare services.     

Life after mandatory insurance: Hawaii providers tide a new wave

While the nation looks to universal access laws as a solution to hospitals' rising costs of caring for the uninsured, laws covering all workers are standard operating procedure in Hawaii. The state's mandatory insurance law was meant to reduce hospitals' indigent-care losses, but losses have continued to mount at some facilities. Despite the overall benefits of the law, Hawaiian hospitals struggle just like their mainland counterparts to survive.     

Universal access versus universal insurance

Debate over the nature of the American healthcare system reemerged in 1989. Advocates of universal health insurance and "universal access" argued their positions in the New England Journal of Medicine, and a Harris poll indicated that 89 percent of Americans feel the United States needs to make a fundamental change in its healthcare system. An adequate assessment of these reform proposals requires a clear understanding of what we want from our healthcare system. In 1981 the U.S. bishops specified six principles for U.S. healthcare policy. The bishops asserted that U.S. policy should (1) assume that healthcare is a right, (2) promote pluralism of delivery systems, (3) promote good health in addition to treating disease, (4) give consumers a choice of providers, (5) make healthcare planning essential, and (6) include methods of controlling costs. The bishops' principles help clarify both proposals' strengths and weaknesses.     

基本卫生服务提供体系及管理体制的国际经验研究

各国卫生体系的经验总结为:全科医生为守门人的、分层的医疗服务体系;重视社区初级卫生保健服务和老龄服务;关注农村居民的卫生保健计划;分权、民主的卫生服务管理体制;公立医院免费提供服务等。     

The cost of health system change: public discontent in five nations.

Many nations have undergone changes in health care financing and services. The public notices policy changes in health care and frequently bears new and unexpected costs or barriers to care unwillingly. This paper presents data from surveys of about 1,000 adults conducted during April-June 1998 in each of five countries--Australia, Canada, New Zealand, the United Kingdom, and the United States--to measure public satisfaction with health care. In no nation is a majority content with the health care system. Different systems pose different problems: In systems with universal coverage, dissatisfaction is with the level of funding and administration, including queues. In the United States, the public is primarily concerned with financial access.     

公立医院社会功能及价值探讨

探讨了我国公立医院存在的社会价值及其功能,认为无论是在国民卫生服务体制下,还是在社会医疗保险体制下,公立医院至少具有5个方面的社会功能:一是提供均等化的医疗服务;二是承担医疗保障功能;三是引导医疗服务市场规范运作;四是保障社会稳定安全;五是培养医学人才,发展医学科技.在医药卫生体制改革中,要充分发挥公立医院的多重作用,才能在较短时间内实现人人享有基本医疗卫生服务的目标.     

公立医院社会功能及价值探讨

探讨了我国公立医院存在的社会价值及其功能,认为无论是在国民卫生服务体制下,还是在社会医疗保险体制下,公立医院至少具有5个方面的社会功能:一是提供均等化的医疗服务;二是承担医疗保障功能;三是引导医疗服务市场规范运作;四是保障社会稳定安全;五是培养医学人才,发展医学科技.在医药卫生体制改革中,要充分发挥公立医院的多重作用,才能在较短时间内实现人人享有基本医疗卫生服务的目标.     

公立医院社会功能及价值探讨

探讨了我国公立医院存在的社会价值及其功能,认为无论是在国民卫生服务体制下,还是在社会医疗保险体制下,公立医院至少具有5个方面的社会功能:一是提供均等化的医疗服务;二是承担医疗保障功能;三是引导医疗服务市场规范运作;四是保障社会稳定安全;五是培养医学人才,发展医学科技.在医药卫生体制改革中,要充分发挥公立医院的多重作用,才能在较短时间内实现人人享有基本医疗卫生服务的目标.     

公立医院社会功能及价值探讨

探讨了我国公立医院存在的社会价值及其功能,认为无论是在国民卫生服务体制下,还是在社会医疗保险体制下,公立医院至少具有5个方面的社会功能:一是提供均等化的医疗服务;二是承担医疗保障功能;三是引导医疗服务市场规范运作;四是保障社会稳定安全;五是培养医学人才,发展医学科技.在医药卫生体制改革中,要充分发挥公立医院的多重作用,才能在较短时间内实现人人享有基本医疗卫生服务的目标.     

公立医院社会功能及价值探讨

探讨了我国公立医院存在的社会价值及其功能,认为无论是在国民卫生服务体制下,还是在社会医疗保险体制下,公立医院至少具有5个方面的社会功能:一是提供均等化的医疗服务;二是承担医疗保障功能;三是引导医疗服务市场规范运作;四是保障社会稳定安全;五是培养医学人才,发展医学科技.在医药卫生体制改革中,要充分发挥公立医院的多重作用,才能在较短时间内实现人人享有基本医疗卫生服务的目标.     

公立医院社会功能及价值探讨

探讨了我国公立医院存在的社会价值及其功能,认为无论是在国民卫生服务体制下,还是在社会医疗保险体制下,公立医院至少具有5个方面的社会功能:一是提供均等化的医疗服务;二是承担医疗保障功能;三是引导医疗服务市场规范运作;四是保障社会稳定安全;五是培养医学人才,发展医学科技.在医药卫生体制改革中,要充分发挥公立医院的多重作用,才能在较短时间内实现人人享有基本医疗卫生服务的目标.     

公立医院社会功能及价值探讨

探讨了我国公立医院存在的社会价值及其功能,认为无论是在国民卫生服务体制下,还是在社会医疗保险体制下,公立医院至少具有5个方面的社会功能:一是提供均等化的医疗服务;二是承担医疗保障功能;三是引导医疗服务市场规范运作;四是保障社会稳定安全;五是培养医学人才,发展医学科技.在医药卫生体制改革中,要充分发挥公立医院的多重作用,才能在较短时间内实现人人享有基本医疗卫生服务的目标.     

公立医院社会功能及价值探讨

探讨了我国公立医院存在的社会价值及其功能,认为无论是在国民卫生服务体制下,还是在社会医疗保险体制下,公立医院至少具有5个方面的社会功能:一是提供均等化的医疗服务;二是承担医疗保障功能;三是引导医疗服务市场规范运作;四是保障社会稳定安全;五是培养医学人才,发展医学科技.在医药卫生体制改革中,要充分发挥公立医院的多重作用,才能在较短时间内实现人人享有基本医疗卫生服务的目标.     

公立医院社会功能及价值探讨

探讨了我国公立医院存在的社会价值及其功能,认为无论是在国民卫生服务体制下,还是在社会医疗保险体制下,公立医院至少具有5个方面的社会功能:一是提供均等化的医疗服务;二是承担医疗保障功能;三是引导医疗服务市场规范运作;四是保障社会稳定安全;五是培养医学人才,发展医学科技.在医药卫生体制改革中,要充分发挥公立医院的多重作用,才能在较短时间内实现人人享有基本医疗卫生服务的目标.     

公立医院社会功能及价值探讨

探讨了我国公立医院存在的社会价值及其功能,认为无论是在国民卫生服务体制下,还是在社会医疗保险体制下,公立医院至少具有5个方面的社会功能:一是提供均等化的医疗服务;二是承担医疗保障功能;三是引导医疗服务市场规范运作;四是保障社会稳定安全;五是培养医学人才,发展医学科技.在医药卫生体制改革中,要充分发挥公立医院的多重作用,才能在较短时间内实现人人享有基本医疗卫生服务的目标.