Auerbach David I, Pearson Marjorie L, Taylor Diana, Battistelli Molly, Sussell Jesse, Hunter Lauren E, Schnyer Christopher, Schneider Eric C
Rand Health Q. 2012 Sep 1;2(3):3. eCollection 2012 Fall.
Use of Sexual and Reproductive Health (SRH) services is projected to grow between 10 and 20 percent from 2006 to 2020. This growth is driven largely by changes in the racial/ethnic make-up of the population of women of reproductive age and an increase in the number of people with insurance coverage because of new health care legislation. Trends in supply and demand for SRH services, particularly for low-income individuals, suggest demand will outstrip supply in the next decade. Nurse Practitioners (NPs) with a women's health focus are key providers of SRH care in Title X-funded clinics, which deliver a significant proportion of U.S. family planning and SRH services to low-income populations. This article looks at why numbers of women's health NPs (WHNPs) have been declining, and are projected to continue to decline, despite significant growth in total numbers of NPs. Barriers to increasing the supply of NPs competent in SRH care-such as reduced funding for WHNP training, increased funding for primary care and geriatric NP training, and a shrinking proportion of WHNPs choosing to work in public health, clinics, and family planning-are identified. From the standpoint that the evolution of the health care delivery system may serve as an opportunity to optimize the delivery of SRH services in the United States, a comprehensive set of options spanning education, federal and state regulations, and emerging models of care delivery are explored to reverse this trend of too few WHNPs, particularly for servicing Title X facilities and their patients.
预计2006年至2020年期间，性与生殖健康（SRH）服务的使用量将增长10%至20%。这一增长主要是由育龄女性人口种族/族裔构成的变化以及由于新的医疗保健立法导致的保险覆盖人数增加所推动的。SRH服务的供需趋势，特别是针对低收入人群的趋势表明，未来十年需求将超过供给。专注于女性健康的执业护士（NPs）是第十章资助诊所中SRH护理的关键提供者，这些诊所为美国低收入人群提供了很大比例的计划生育和SRH服务。本文探讨了为什么女性健康NPs（WHNPs）的数量一直在下降，并且预计还将继续下降，尽管NPs总数有显著增长。文中指出了增加具备SRH护理能力的NPs供应的障碍，比如WHNP培训资金减少、初级护理和老年NP培训资金增加，以及选择在公共卫生、诊所和计划生育领域工作的WHNPs比例不断缩小。从医疗保健提供系统的演变可能成为优化美国SRH服务提供的契机这一角度出发，本文探索了一系列全面的选择，涵盖教育、联邦和州法规以及新兴的护理提供模式，以扭转WHNPs数量过少的趋势，特别是为第十章资助机构及其患者提供服务。
