Schuster Mark A, Chung Paul J, Vestal Katherine D
Harvard Medical School, Boston, USA.
Future Child. 2011 Fall;21(2):91-116. doi: 10.1353/foc.2011.0017.
All children, even the healthiest, have preventive and acute health care needs. Moreover, a growing number of children are chronically ill, with preventive, acute, and ongoing care needs that may be much more demanding than those for healthy children. Because children are unable to care for themselves, their parents are expected to provide a range of health care services without which the current health care system for children would not function. Under this "shadow health care system," parents or parent surrogates often need to be with the child, a requirement that can create difficulties for working parents, particularly for those whose children are chronically ill. How federal, state, and employer policies and practices mesh with the child health care needs of families is therefore a central issue in any discussion about work and family balance. In this article Mark Schuster, Paul Chung, and Katherine Vestal describe the health care needs of children; the essential health care responsibilities of parents; the perspective of employers; and the existing network of federal, state, and local family leave benefits that employed parents can access. They also identify current gaps in policies that leave unmet the needs of both parents and their employers. The authors suggest the outlines of a national family leave policy that would protect the interests of parents and employers. In essence, such a policy would build on the federal Family and Medical Leave Act, which gives some workers time off with no advance notice required and no loss of job or health insurance. But it would also include elements of California's Paid Family Leave Insurance, which expands coverage to more workers and provides partial pay during leave. Employers could be given some financial protections as well as protections against employee fraud and abuse. Such a policy, the authors conclude, would help to provide security to parents, minimize effects on employers, raise societal expectations for family-friendly work environments, and help maintain the parental shadow system of care on which health care professionals depend.
所有儿童，即使是最健康的儿童，都有预防保健和急症医疗需求。此外，患有慢性病的儿童数量日益增多，他们的预防、急症及持续护理需求可能比健康儿童的需求要高得多。由于儿童无法自理，他们的父母需要提供一系列医疗服务，否则当前的儿童医疗保健系统将无法运转。在这个“影子医疗保健系统”下，父母或代行父母职责者常常需要陪伴孩子，这一要求给有工作的父母带来了困难，尤其是那些孩子患有慢性病的父母。因此，在任何关于工作与家庭平衡的讨论中，联邦、州和雇主的政策及做法如何与家庭的儿童医疗保健需求相契合都是核心问题。在本文中，马克·舒斯特、保罗·钟和凯瑟琳·维斯塔尔描述了儿童的医疗保健需求、父母的基本医疗保健责任、雇主的观点，以及在职父母可以享有的联邦、州和地方家庭休假福利的现有网络。他们还指出了当前政策中存在的差距，这些差距使得父母及其雇主的需求都无法得到满足。作者们提出了一项国家家庭休假政策的框架，该政策将保护父母和雇主的利益。从本质上讲，这样一项政策将以联邦《家庭和医疗休假法》为基础，该法案赋予一些员工无需提前通知即可休假的权利，且不会导致失业或失去医疗保险。但它也将包括加利福尼亚州带薪家庭休假保险的一些内容，该保险将覆盖范围扩大到更多员工，并在休假期间提供部分薪资。雇主可以得到一些财务保护以及防止员工欺诈和滥用的保护。作者们总结说，这样一项政策将有助于为父母提供保障，并将对雇主的影响降至最低，提高社会对家庭友好型工作环境的期望，并有助于维持医疗保健专业人员所依赖的父母影子护理系统。
