Johnson Kay A
Dartmouth Medical School, Hanover, New Hampshire, USA.
Matern Child Health J. 2006 Sep;10(5 Suppl):S85-91. doi: 10.1007/s10995-006-0125-8.
Policy and finance barriers reduce access to preconception care and, reportedly, limit professional practice changes that would improve the availability of needed services. Millions of women of childbearing age (15-44) lack adequate health coverage (i.e., uninsured or underinsured), and others live in medically underserved areas. Service delivery fragmentation and lack of professional guidelines are additional barriers. This paper reviews barriers and opportunities for financing preconception care, based on a review and analysis of state and federal policies. We describe states' experiences with and opportunities to improve health coverage, through public programs such as Medicaid, Medicaid waivers, and the State Children's Health Insurance Program (SCHIP). The potential role of Title V and of community health centers in providing primary and preventive care to women also is discussed. In these and other public health and health coverage programs, opportunities exist to finance preconception care for low-income women. Three major policy directions are discussed. To increase access to preconception care among women of childbearing age, the federal and state governments have opportunities to: (1) improve health care coverage, (2) increase the supply of publicly subsidized health clinics, and (3) direct delivery of preconception screening and interventions in the context of public health programs.
政策和资金障碍减少了孕前保健服务的可及性，据报道，还限制了有助于提高所需服务可及性的专业实践变革。数百万育龄妇女（15至44岁）缺乏足够的医保覆盖（即未参保或参保不足），还有一些人生活在医疗服务欠缺地区。服务提供分散以及缺乏专业指南也是额外的障碍。本文基于对州和联邦政策的回顾与分析，审视了孕前保健融资的障碍与机遇。我们描述了各州在通过诸如医疗补助、医疗补助豁免以及儿童健康保险计划（SCHIP）等公共项目改善医保覆盖方面的经验与机遇。还讨论了第五章以及社区健康中心在为女性提供初级和预防保健方面的潜在作用。在这些及其他公共卫生和医保覆盖项目中，存在为低收入女性的孕前保健提供资金的机遇。文中讨论了三个主要的政策方向。为增加育龄妇女获得孕前保健服务的机会，联邦和州政府有机会：（1）改善医保覆盖，（2）增加由公共补贴的健康诊所的供给，以及（3）在公共卫生项目背景下直接提供孕前筛查和干预措施。
