Miller C L, Margolis L H, Schwethelm B, Smith S
Department of Public Health Policy and Administration, School of Public Health, University of Michigan.
Am J Public Health. 1989 Jan;79(1):62-4. doi: 10.2105/ajph.79.1.62.
By the middle of the second year of the Michigan Prenatal/Postpartum Care (PPC) program to provide pregnancy-related services to low income women who were ineligible for Medicaid or other insurance, only 25 per cent of the participating health departments were enrolling greater than 90 per cent of contracted potential clients. Using a survey of program directors and relevant state documents, we identified several barriers to successful implementation: institutional (program complexity, high levels of administrative concerns along with low levels of communication between local health departments and providers); economic (inadequate resources for provider reimbursement, outreach, transportation, high-risk pregnancies, or administrative overhead); psychological (servicing populations with multiple and hard to care for problems, potential discomfort of low income women with traditional providers); and informational (insufficient information about the program infiltrating the target community).
在密歇根产前/产后护理（PPC）项目开展的第二年中期，该项目旨在为不符合医疗补助或其他保险资格的低收入女性提供与怀孕相关的服务，但只有25%的参与项目的卫生部门登记的潜在客户数量超过了合同规定的90%。通过对项目主管进行调查并查阅相关州文件，我们确定了成功实施该项目的几个障碍：制度方面（项目复杂、行政问题繁多，同时地方卫生部门与提供者之间沟通不足）；经济方面（用于支付提供者报酬、外展服务、交通、高危妊娠或行政开支的资源不足）；心理方面（为有多种且难以照料问题的人群提供服务，低收入女性可能对传统提供者感到不适）；以及信息方面（关于该项目渗透到目标社区的信息不足）。
