Davis K, Lillie-Blanton M, Lyons B, Mullan F, Powe N, Rowland D
Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205.
Milbank Q. 1987;65 Suppl 1:213-47.
Most of the improvement--both absolute and relative--in the health status of black Americans over the past two decades can be traced to major gains in access to health care services. Public payment programs, most notably Medicaid and Medicare, have not only reduced financial barriers, but have also combatted those of racial discrimination. Other federal programs supporting targeted local services have been especially effective in reducing infant mortality. But the redistributive effects have been uneven and unequal across populations; many categorical gaps remain and increasing numbers are potentially without access to essential primary care services.
在过去二十年里，美国黑人健康状况的改善，无论是绝对的还是相对的，大部分都可归因于获得医疗保健服务方面取得的重大进展。公共支付项目，最显著的是医疗补助计划和医疗保险，不仅减少了经济障碍，还对抗了种族歧视障碍。其他支持有针对性的地方服务的联邦项目在降低婴儿死亡率方面尤其有效。但再分配效应在不同人群中不均衡且不平等；许多类别差距依然存在，而且越来越多的人可能无法获得基本的初级保健服务。
