McCarthy M, Jacquart K, Quam L
School of Public Affairs, University of Texas, USA.
West J Med. 1995 Sep;163(3 Suppl):45-9.
Within the United States, rural residents encounter a greater number of barriers in accessing health care services than their urban counterparts. In general, rural Americans have less access to both family planning services and managed care delivery systems. Given the rapid changes in health care, we reviewed the implications for the provision and integration of family planning and managed care services in rural areas, where there is limited experience in establishing working relationships between those services. In many instances, family planning services are well established in rural areas where managed care has not yet penetrated. Our case study in Minnesota suggests that, although managed care and family planning services are developing in rural areas, there is little evidence of collaboration. Several innovative and successful family planning projects do exist in rural areas, however, and serve as models of successful population-based programs that could work well with health plans. Although this study concentrated on the provision and utilization of subsidized family planning services, there is a compelling need for further work to determine accurately where rural residents are accessing such services and how the expansion of managed care will affect the delivery of reproductive health care.
在美国，农村居民在获得医疗保健服务方面遇到的障碍比城市居民更多。总体而言，美国农村居民获得计划生育服务和管理式医疗服务体系的机会较少。鉴于医疗保健领域的快速变化，我们审视了在农村地区提供和整合计划生育与管理式医疗服务所产生的影响，而在这些地区，建立这些服务之间的合作关系经验有限。在许多情况下，计划生育服务在管理式医疗尚未渗透的农村地区已根深蒂固。我们在明尼苏达州的案例研究表明，尽管农村地区的管理式医疗和计划生育服务正在发展，但几乎没有合作的迹象。不过，农村地区确实存在一些创新且成功的计划生育项目，这些项目可作为能与健康计划良好配合的成功的基于人群的项目典范。尽管本研究集中于补贴性计划生育服务的提供和利用，但迫切需要进一步开展工作，以准确确定农村居民从何处获得此类服务，以及管理式医疗的扩张将如何影响生殖健康护理的提供。
