Halfon N, Inkelas M, Wood D
Child and Family Health Program, School of Public Health, University of California Los Angeles 90024-1772, USA.
Annu Rev Public Health. 1995;16:447-72. doi: 10.1146/annurev.pu.16.050195.002311.
Public health and medical care interventions have produced dramatic changes in the health of children in the United States. Emerging new morbidities such as behavioral and learning disorders, and child abuse and neglect, highlight the lack of an integrated system of health. Children's developmental vulnerability, dependency, and unique morbidities have been underemphasized in the organization and delivery of health care. The Andersen and Aday model of health care utilization is used to describe financial and nonfinancial barriers to care for children that include family characteristics and organizational characteristics of the health system. Case studies of immunization delivery, children with chronic illness, and mobile populations of children reveal the mismatch between the health care system and children's basic health needs. Integrated service models for high-risk populations of children represent an essential mechanism for coordinating the delivery of medical, developmental, educational, and social services needed by children and families. Universal, coordinated public health and medical services of adequate scope and quality should be assured for children through market and health system reform.
公共卫生和医疗保健干预措施已使美国儿童的健康状况发生了巨大变化。诸如行为和学习障碍以及虐待和忽视儿童等新出现的发病率凸显了缺乏综合卫生系统的问题。儿童的发育脆弱性、依赖性和独特的发病率在医疗保健的组织和提供过程中一直未得到充分重视。安徒生和阿代的医疗保健利用模型用于描述儿童获得医疗保健的财务和非财务障碍，这些障碍包括家庭特征和卫生系统的组织特征。免疫接种、慢性病儿童和流动儿童群体的案例研究揭示了医疗保健系统与儿童基本健康需求之间的不匹配。针对高危儿童群体的综合服务模式是协调提供儿童及其家庭所需的医疗、发育、教育和社会服务的重要机制。应通过市场和卫生系统改革，为儿童确保范围足够且质量合格的普遍、协调的公共卫生和医疗服务。
