Taylor D H, Ricketts T C, Berman J L, Kolimaga J T
North Carolina Rural Health Research Program, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill 27599-7590.
Public Health Rep. 1992 Sep-Oct;107(5):523-9.
In the period 1985-89, there was a severe drop in obstetrical services in rural areas of North Carolina, partly because of rising malpractice insurance rates. The State government responded with the Rural Obstetrical Care Incentive (ROCI) Program that provides a malpractice insurance subsidy of up to $6,500 per participating physician per year. Enacted into law in 1988, the ROCI Program was expanded in 1991, making certified nurse midwives eligible to receive subsidies of up to $3,000 per year. To participate, practitioners must provide obstetrical care to all women, regardless of their ability to pay for services. Total funding for the program has increased from $240,000 to $840,000, in spite of extreme budgetary constraints faced by the State. The program and how its implementation has maintained or increased access to obstetrical care in participating counties are described on the basis of site visits to local health departments in participating counties and data from the North Carolina Division of Maternal and Child Health. The program is of significance to policy makers nationwide as both a response to rising malpractice insurance rates and reduced access to obstetrical care in rural areas, and as an innovative, nontraditional State program in which the locus of decision making is at the county level.
在1985年至1989年期间，北卡罗来纳州农村地区的产科服务急剧减少，部分原因是医疗事故保险费率上升。州政府推出了农村产科护理激励（ROCI）计划，为每位参与的医生每年提供高达6500美元的医疗事故保险补贴。ROCI计划于1988年成为法律，并于1991年扩大，使注册护士助产士有资格每年获得高达3000美元的补贴。要参与该计划，从业者必须为所有妇女提供产科护理，无论她们是否有能力支付服务费用。尽管该州面临极端的预算限制，但该计划的总资金已从24万美元增加到84万美元。根据对参与县的当地卫生部门的实地考察以及北卡罗来纳州母婴健康司的数据，描述了该计划及其实施如何在参与县维持或增加了产科护理的可及性。该计划对全国政策制定者具有重要意义，既是对医疗事故保险费率上升和农村地区产科护理可及性降低的回应，也是一个创新的、非传统的州计划，其决策地点在县一级。
