Taylor D H
Center for Health Policy, Law and Management, Terry Sanford Institute of Public Policy, Duke University, Durham, NC 27708, USA.
J Rural Health. 1999 Winter;15(1):55-60. doi: 10.1111/j.1748-0361.1999.tb00598.x.
There has been a shift during the past 60 years from a broad notion of the entire nation as underserved to a more focused effort to identify particular areas (often rural) thought to be underserved. This approach was formalized with the advent of the war on poverty. This focused approach has been cemented during the past 30 years, in part by the success of various federal health center programs that have remained funded during this period in spite of opposition. This paper concludes that the consensus view that rural underserved areas represent an "exception" phenomenon that is properly addressed with special responses (organizations or physicians) has had two major effects: (1) the political survivability of focused programmatic responses (such as Community Health Centers) has been enhanced; and (2) the existence of an "elastic net" policy network to advocate for the expansion of such remedial efforts may play a contributory role in helping to defeat comprehensive health reform.
在过去60年里，出现了一种转变，从认为整个国家医疗服务不足的宽泛概念，转向更有针对性地努力去识别那些被认为医疗服务不足的特定地区（通常是农村地区）。随着反贫困战争的到来，这种方法被正式确立。在过去30年里，这种有针对性的方法得到了巩固，部分原因是各种联邦健康中心项目取得了成功，尽管面临反对，但这些项目在此期间仍获得了资金支持。本文得出结论，即农村医疗服务不足地区代表一种“特殊”现象，需要通过特殊应对措施（机构或医生）来妥善解决的共识观点产生了两大影响：（1）增强了有针对性的项目应对措施（如社区健康中心）在政治上的可存续性；（2）倡导扩大此类补救措施的“弹性网络”政策网络的存在，可能在助力挫败全面医疗改革方面起到了推波助澜的作用。
