Mayster V, Waitzkin H, Hubbell F A, Rucker L
North Orange County Community Clinic, Anaheim, CA 92801.
Int J Health Serv. 1992;22(2):317-29. doi: 10.2190/HFX4-R2N7-XVET-VWU8.
Access to health care for the medically indigent has emerged as a major policy issue throughout the United States. Because no national health program assures entitlement to basic services, practitioners and patients must cope with barriers to access on the local level. The authors report several separate but integrated strategies that a community-based coalition has used to achieve improvements in indigent care within a single county. Research strategies have involved short-term investigations of barriers to needed services, so that local awareness of the problem would increase rapidly. Political strategies have attempted to improve the county government's administrative procedures and financial support of services for the poor, to modify the practices of local health care institutions, and to influence statewide and national policies affecting local conditions. Legal strategies have involved the participation of attorneys who represent clients unable to receive care and who could initiate litigation as appropriate. Each of these strategies contains weaknesses as well as strengths. Although such advocacy efforts do not achieve a coherent system guaranteeing access, they can substantially improve the availability of local services.
为贫困人口提供医疗服务已成为美国全国性的重大政策问题。由于没有全国性的医疗项目确保人们有权获得基本服务，从业者和患者必须应对地方层面上的就医障碍。作者报告了一个社区联盟在一个县内为改善贫困人群医疗服务所采用的几个相互独立但又相互整合的策略。研究策略包括对获得所需服务的障碍进行短期调查，以便迅速提高当地对该问题的认识。政治策略试图改进县政府的行政程序以及对贫困人群服务的财政支持，改变当地医疗机构的做法，并影响州和国家层面上影响当地情况的政策。法律策略涉及代表无法获得医疗服务的当事人并可在适当时提起诉讼的律师的参与。这些策略各有优缺点。尽管此类倡导工作未能建立起一个确保就医机会的连贯体系，但它们可以大幅提高当地服务的可及性。
