Rosenbaum S, Hughes D C, Johnson K
Children's Defense Fund, Washington, DC 20002.
Med Care. 1988 Apr;26(4):315-32. doi: 10.1097/00005650-198804000-00002.
Millions of low-income children and women of childbearing age are completely uninsured. Medicaid, the nation's largest public health financing program for the poor, is an inadequate resource for uninsured families with children. By 1984, the program served only 46% of the poor and near-poor, down from 65% in 1976. To assess the availability of maternity and pediatric services for low income uninsured women and children, a survey of 51 Title V Maternal and Child Health agency officials was conducted in 1986. While nearly all states (48) offer some prenatal care programs for indigent women, restrictive eligibility requirements and limited distribution meant that these programs reached only a small proportion of those in need. Only one state, Massachusetts, offered a truly statewide program to all uninsured pregnant women with incomes under 185% of the poverty level. Twenty-three states reported the existence of inpatient maternity programs for indigent women. Yet these, too, were extremely limited. Sixteen programs restricted funds either to women who participated in certain designated maternity programs or else only to those who were identified as high risk prior to the labor and delivery period. Fifteen state agencies reported that hospitals were denying admission to women about to deliver. Another 13 reported that hospitals were denying admission to women not yet in "active" labor. Six additional states were aware of patient dumping but did not identify the specific populations that were affected. Forty-six states reported the existence of pediatric outpatient programs. However, the majority (30) offered only "well-child" care. Seven states maintained pediatric programs limited to only certain ages of children; three of these imposed an age requirement as low as 2 years or younger. Only two states reported the availability of any pediatric inpatient programs financed or administered by Title V agencies other than those for children with special health care needs.
数以百万计的低收入儿童和育龄妇女完全没有医疗保险。医疗补助计划是美国为贫困人口设立的最大的公共卫生筹资项目，但对于有孩子的未参保家庭来说，这一资源并不充足。到1984年，该计划只为46%的贫困人口和接近贫困人口提供服务，低于1976年的65%。为了评估低收入未参保妇女和儿童获得孕产妇和儿科服务的情况，1986年对51名第五章母婴健康机构官员进行了一项调查。虽然几乎所有州（48个）都为贫困妇女提供了一些产前护理项目，但严格的资格要求和有限的分布意味着这些项目只惠及了一小部分有需要的人。只有马萨诸塞州为所有收入低于贫困线185%的未参保孕妇提供了真正覆盖全州的项目。23个州报告称存在针对贫困妇女的住院孕产妇项目。然而，这些项目也极为有限。16个项目将资金限制在参加某些指定孕产妇项目的妇女，或者只限于那些在分娩期之前被确定为高危的妇女。15个州机构报告称，医院拒绝即将分娩的妇女入院。另外13个州报告称，医院拒绝尚未进入“活跃”分娩期的妇女入院。另外6个州知道有病人被遗弃的情况，但没有指明受影响的具体人群。46个州报告称存在儿科门诊项目。然而，大多数州（30个）只提供“儿童健康”护理。7个州维持的儿科项目只限于特定年龄段的儿童；其中3个州规定的年龄要求低至2岁或更小。只有两个州报告称有第五章机构资助或管理的儿科住院项目，不包括那些有特殊医疗需求的儿童。
