Ireys H T, Nelson R P
Department of Maternal and Child Health, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205.
Pediatrics. 1992 Sep;90(3):321-7.
Title V of the Social Security Act of 1935 established the nation's first categorical health care program for children: the Crippled Children's Service. In 1985, federal legislation changed the name of the Crippled Children's Service to the Program for Children With Special Health Care Needs. Four years later, new amendments to Title V dramatically altered the Program's mission. States are now required to spend 30% of the funds from the Maternal and Child Health Services block grant on children with special health care needs and to take specific steps toward improving the service system for these children and their families. The new mandate is the only current foundation of a national health policy for children with special health care needs. The 1989 law substantially broadens the mission of the state programs and explicitly recognizes that all children with a special health care need should have access to an appropriate, community-based system of care monitored by state Children with Special Health Care Needs agencies. In addition, states are now required to conduct needs assessments pertaining to these children, to foster local systems of care, and to ensure a high quality of community-based services. Understanding the implications of the new amendments is essential because pediatricians and other child health care professionals have key roles to play in implementing these new policies.
1935年的《社会保障法》第五章设立了美国首个针对儿童的分类医疗保健项目：残疾儿童服务项目。1985年，联邦立法将残疾儿童服务项目更名为有特殊医疗保健需求儿童项目。四年后，第五章的新修正案极大地改变了该项目的使命。现在要求各州将母婴健康服务整笔拨款中的30%用于有特殊医疗保健需求的儿童，并采取具体措施改善针对这些儿童及其家庭的服务体系。这项新指令是目前针对有特殊医疗保健需求儿童的国家卫生政策的唯一基础。1989年的法律大幅拓宽了州项目的使命，并明确承认所有有特殊医疗保健需求的儿童都应能获得由州有特殊医疗保健需求儿童机构监管的、适当的、基于社区的医疗保健体系。此外，现在要求各州对这些儿童进行需求评估，建立地方医疗保健体系，并确保高质量的社区服务。理解新修正案的影响至关重要，因为儿科医生和其他儿童医疗保健专业人员在实施这些新政策方面发挥着关键作用。
