Fossett J W, Perloff J D, Peterson J A, Kletke P R
Department of Public Administration and Policy, Graduate School of Public Affairs, State University of New York, Albany 12222.
Milbank Q. 1990;68(1):111-41.
The growing concentration of lower-income groups, including Medicaid patients, in homogeneous inner-city areas such as Chicago casts considerable doubt on the effectiveness of expanding Medicaid eligibility and raising physician reimbursement to improve access to maternity care. There are few private office-based physicians providing prenatal care in these areas, and most pregnant women and infants are treated by private-office-based physicians in very high-volume practices, prompting concern about the quality of care. Increasing the supply of providers is required to enhance access to maternity services in inner cities. Expanding eligibility and raising reimbursement rates are more apt to benefit "near-poor" women, who are more spatially dispersed, than clustered-poor female populations.
包括医疗补助计划患者在内的低收入群体越来越集中在芝加哥等城市中心的同质化区域，这使得人们对扩大医疗补助资格范围以及提高医生报销费用以改善孕产妇护理服务可及性的有效性产生了很大怀疑。在这些地区，很少有私人诊所医生提供产前护理，大多数孕妇和婴儿由高诊疗量的私人诊所医生治疗，这引发了对护理质量的担忧。为了提高城市中心孕产妇服务的可及性，需要增加医疗服务提供者的数量。扩大资格范围和提高报销率更有可能使分布更为分散的“准贫困”女性受益，而非集中贫困的女性群体。
