Mayster V, Waitzkin H, Hubbell F A, Rucker L
Division of General Internal Medicine and Primary Care, University of California, Irvine.
JAMA. 1990 Jan 12;263(2):262-8.
Access to health care for the medically indigent has emerged as a major policy issue throughout the United States. Because no national health program ensures entitlement to basic services, practitioners and patients must cope with barriers to access on the local level. We 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 state and national policies that affect 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 that guarantees access, they can substantially improve the availability of local services.
为贫困人群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计划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。我们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关联的策略。研究策略包括对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为贫困人口提供服务的行政程序和财政支持，改变当地医疗机构的做法，并影响那些影响当地情况的州和国家政策。法律策略涉及代表无法获得医疗服务的客户且能在适当时提起诉讼的律师的参与。这些策略各有优缺点。尽管这种倡导努力无法建立一个保证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。
