Nesbitt T S
Birth. 1996 Sep;23(3):161-5. doi: 10.1111/j.1523-536x.1996.tb00477.x.
Despite huge health care expenditures, many rural areas of the United States are without adequate access to basic maternity services. Hospital closures and changes in reimbursement have created new threats, even in areas with functional systems of delivering maternity care. New models of care must be developed that take advantage of attributes of low-volume rural maternity units, increase the number of collaborative practices among various providers of maternity services, and judiciously apply new technologies to bring perinatal expertise into the rural hospital when appropriate. Local access to maternity care in rural communities is essential to improve birth outcomes and lower costs. Standardization of management of obstetric emergencies and advances in telecommunication technology may make these low-technology, isolated communities safer than they have been in the past. Changes in health care financing, particularly managed care with capitation, may further support these changes.
尽管美国在医疗保健方面投入了巨额资金，但美国许多农村地区仍无法充分获得基本的孕产妇服务。医院关闭和报销政策的变化带来了新的威胁，即使在拥有正常孕产妇护理服务体系的地区也是如此。必须开发新的护理模式，利用低容量农村产科单位的特点，增加各类孕产妇服务提供者之间的协作实践数量，并明智地应用新技术，以便在适当的时候将围产期专业知识引入农村医院。农村社区当地的孕产妇护理服务对于改善分娩结局和降低成本至关重要。产科急诊管理的标准化以及电信技术的进步可能会使这些技术水平较低、较为孤立的社区比过去更加安全。医疗保健融资的变化，尤其是按人头付费的管理式医疗，可能会进一步支持这些变革。
