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Title of Journal: Matern Child Health J

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Abbravation: Maternal and Child Health Journal

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Springer US

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DOI

10.1002/hep.22844

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1573-6628

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Public Finance Policy Strategies to Increase Acces

Authors: Kay A Johnson
Publish Date: 2006/06/27
Volume: 10, Issue: 1, Pages: 85-91
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Abstract

Policy and finance barriers reduce access to preconception care and reportedly limit professional practice changes that would improve the availability of needed services Millions of women of childbearing age 15–44 lack adequate health coverage ie uninsured or underinsured and others live in medically underserved areas Service delivery fragmentation and lack of professional guidelines are additional barriers This paper reviews barriers and opportunities for financing preconception care based on a review and analysis of state and federal policies We describe states’ experiences with and opportunities to improve health coverage through public programs such as Medicaid Medicaid waivers and the State Childrens Health Insurance Program SCHIP The potential role of Title V and of community health centers in providing primary and preventive care to women also is discussed In these and other public health and health coverage programs opportunities exist to finance preconception care for lowincome women Three major policy directions are discussed To increase access to preconception care among women of childbearing age the federal and state governments have opportunities to 1 improve health care coverage 2 increase the supply of publicly subsidized health clinics and 3 direct delivery of preconception screening and interventions in the context of public health programsThe overarching goal of preconception care is to provide health promotion screening and interventions for the more than 62 million women of childbearing age 1 to reduce risk factors that might affect future pregnancies 2 3 4 As elsewhere in this supplement preconception care is defined as a set of interventions that aim to identify and modify biomedical behavioral and social risks to a womans health or pregnancy outcome through prevention and management emphasizing those factors which must be acted on before conception or early in pregnancy to have maximal impact It includes care before a first pregnancy or between pregnancies commonly known as interconception or internatal care 5 and care that would typically be delivered in primary care settings 4Health professional leaders and professional organizations’ guidelines have called for improvements in preconception care for more than 20 years 4 6 7 8 9 and several reviews of the literature have assessed the evidence for specific interventions and documented their effectiveness 10 11 Without changes in financing however it appears unlikely that the nation will improve its preconception health and thereby improve the health of women their children and their families Since federal and state policies are important drivers of health care financing this paper provides suggestions on how policymakers can improve financing for preconception care 12Although many observers have suggested that providers would deliver more preconception care if they could bill payers for the service 13 a closer look at the situation suggests that more complex changes in womens health care financing may be necessary to support widespread use of preconception care Affordability of care is a major concern for many women 14 Many women lack basic health coverage particularly nonpregnant lowincome women who do not meet of Medicaids low income eligibility levels 15 Securing private insurance coverage for additional preventive services may require more and better evidence about the effectiveness of interventions 4 Other barriers to financing are more mechanical Financing is required for an ongoing care process over a period of years and across the lifespan not a single visit Billing mechanisms and codes need refinement in addition costbenefit analyses and ongoing alignment with newly emerging approaches to care will also be required 16Financial barriers to health care access are widespread in the United States with many lowincome individuals having no or inadequate health coverage The Kaiser Family Foundation’s Womens Health Survey 17 does not focus on preconception care but some of its results are relevant to understanding barriers to womens health care Among women of childbearing age 18 to 44 years 30 percent reported that they delayed or went without care because of cost Moreover 21 of women of all nonelderly women 18 to 64 years in the survey reported that they did not fill a prescription for medication because of cost including 40 of uninsured women 17Millions of Americans live without health coverage Nearly 17 million American women are uninsured 17 Onethird of low income women with income less than 200 percent of the federal poverty level half of women with disabilities and 18 percent of all nonelderly women were uninsured in 2003 18 Younger women were more likely than older women to be uninsured Hispanic Asian and Black women were more likely than nonHispanic white women to be uninsured reflecting their income and employment status patterns ie more likely to have incomes below 200 percent of poverty and less likely to be employed in jobs that offer health insurance 17 Moreover recent data indicate that women are more likely to lose coverage than men Between 2002 and 2003 nearly 900000 women ages 18 to 64 became uninsured compared to 600000 men 53 and 47 percent respectively Such losses are attributed primarily to welfare reform policies and employerbased coverage trends 19Data for 2002–2003 reveal that the percentage of women ages 18–64 who were uninsured varies substantially ranging from 30 percent in Texas to 8 percent in Minnesota The proportion of uninsured lowincome adult women shows similar variation ranging from more than 50 percent in Texas to less than 25 percent in Massachusetts Minnesota Tennessee and Wisconsin Although to some extent these differences reflect Medicaid eligibility policy the statetostate variations also reflect employment patterns For example Minnesota had the highest percentage of adult women with private coverage and a fairly low proportion of women covered by Medicaid 83 percent and 8 percent respectively In contrast in Tennessee under policies in effect at that time 17 percent of adult women were Medicaid beneficiaries and only 70 percent had private coverage 20


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Other Papers In This Journal:

  1. A Perspective of Preconception Health Activities in the United States
  2. Birth Characteristics Associated With Early Intervention Referral, Evaluation for Eligibility, and Program Eligibility in the First Year of Life
  3. The Relationship of Depressive Symptoms to Parenting Competence and Social Support in Inner-City Mothers of Young Children
  4. Supporting Pregnant Aboriginal and Torres Strait Islander Women to Quit Smoking: Views of Antenatal Care Providers and Pregnant Indigenous Women
  5. Gestational Age at First Antenatal Care Visit in Malawi
  6. Family Perceptions of Shared Decision-Making with Health Care Providers: Results of the National Survey of Children with Special Health Care Needs, 2009–2010
  7. Family Perceptions of Shared Decision-Making with Health Care Providers: Results of the National Survey of Children with Special Health Care Needs, 2009–2010
  8. Reasons for Mother–Infant Bed-Sharing: A Systematic Narrative Synthesis of the Literature and Implications for Future Research
  9. Dose and Timing of Prenatal Alcohol Exposure and Maternal Nutritional Supplements: Developmental Effects on 6-Month-Old Infants
  10. Pre-pregnancy Obesity as a Modifier of Gestational Diabetes and Birth Defects Associations: A Systematic Review
  11. A Qualitative Study to Understand Nativity Differences in Breastfeeding Behaviors Among Middle-Class African American and African-Born Women
  12. U.S. Provider Reported Folic Acid or Multivitamin Ordering for Non-Pregnant Women of Childbearing Age: NAMCS and NHAMCS, 2005–2006
  13. The Impact of Community Health Professional Contact Postpartum on Breastfeeding at 3 Months: A Cross-Sectional Retrospective Study
  14. The Correlation Between Postpartum Depression and Health Status
  15. Preconception and the Young Cancer Survivor
  16. Infant Feeding Decision-Making and the Influences of Social Support Persons Among First-Time African American Mothers
  17. Formative Research to Examine Collaboration Between Special Supplemental Nutrition Program for Woman, Infants, and Children and Head Start Programs
  18. Impact of Maternal Glucose and Gestational Weight Gain on Child Obesity over the First Decade of Life in Normal Birth Weight Infants
  19. Sleep Moderates and Mediates the Relationship Between Acculturation and Depressive Symptoms in Pregnant Mexican-American Women
  20. Ascertainment of Medicaid Payment for Delivery on the Iowa Birth Certificate: Is Accuracy Sufficient for Timely Policy and Program Relevant Analysis?
  21. Pre-Pregnancy Body Mass Index and Weight Gain During Pregnancy: Relations with Gestational Diabetes and Hypertension, and Birth Outcomes
  22. A Nationally Representative Study of Early Childhood Home Visiting Service Use in the United States
  23. Consultative Care Coordination Through the Medical Home for CSHCN: A Randomized Controlled Trial
  24. Prevalence of Medical Conditions Potentially Amenable to Cellular Therapy among Families Privately Storing Umbilical Cord Blood
  25. Rates and Success Rates of Trial of Labor After Cesarean Delivery in the United States, 1990–2009
  26. Genetic Counseling, Insurance Status, and Elements of Medical Home: Analysis of the National Survey of Children with Special Health Care Needs
  27. Does a Medical Home Mediate Racial Disparities in Unmet Healthcare Needs Among Children with Special Healthcare Needs?
  28. Physical Activity and Risk of Small-for-Gestational-Age Birth Among Predominantly Puerto Rican Women
  29. Maternal Health Risk Assessment and Behavioral Intervention in the NICU Setting Following Very Low Birth Weight Delivery
  30. A Process Evaluation of the WV Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Dissemination Initiative: Assessing the Fidelity and Impact of Delivery for State-Wide, Home-Based Healthy Start Services
  31. Determinants of the Uptake of the Full Dose of Diphtheria–Pertussis–Tetanus Vaccines (DPT3) in Northern Nigeria: A Multilevel Analysis
  32. Awareness and Intake of Folic Acid for the Prevention of Neural Tube Defects Among Lebanese Women of Childbearing Age
  33. Exploring Maternal Patterns of Dietary Caffeine Consumption Before Conception and During Pregnancy
  34. Utilization of Folic Acid and Iron Supplementation Services by Pregnant Women Attending an Antenatal Clinic at a Regional Referral Hospital in Kenya
  35. The Association of Parental Coping and Childhood Injury
  36. Predictors of Breastfeeding in Overweight and Obese Women: Data From Active Mothers Postpartum (AMP)
  37. Health Behaviors Among Women Using Fertility Treatment
  38. Variation in Birth Outcomes by Mother’s Country of Birth Among Non-Hispanic Black Women in the United States
  39. Does Health Insurance Continuity Among Low-income Adults Impact Their Children’s Insurance Coverage?
  40. Preconception Care Between Pregnancies: The Content of Internatal Care
  41. Access to care for children with autism in the context of state Medicaid reimbursement
  42. Prenatal Programming of Childhood Overweight and Obesity
  43. Evaluation of a Cross Cultural Curriculum: Changing Knowledge, Attitudes and Skills in Pediatric Residents
  44. Fathering: The Relationship Between Fathers’ Residence, Fathers’ Sociodemographic Characteristics, and Father Involvement
  45. Empowering Head Start to Improve Access to Good Oral Health for Children from Low Income Families
  46. Measuring Women’s Cumulative Neighborhood Deprivation Exposure Using Longitudinally Linked Vital Records: A Method for Life Course MCH Research
  47. Afraid of Delivering at the Hospital or Afraid of Delivering at Home: A Qualitative Study of Thai Hmong Families’ Decision-Making About Maternity Services
  48. Association Between Low Dairy Intake During Pregnancy and Risk of Small-for-Gestational-Age Infants
  49. Electronic Medical Record Use and Maternal and Child Care and Health
  50. Prevention of Secondary Conditions in Fetal Alcohol Spectrum Disorders: Identification of Systems-Level Barriers
  51. Prevalence of Serious Psychological Distress and Mental Health Treatment in a National Sample of Pregnant and Postpartum Women
  52. The Agency for Healthcare Research and Quality’s Children’s Health Research Portfolio
  53. Maternal Education and Child Healthcare in Bangladesh
  54. Smoking Among Pregnant Women with Medicaid Insurance: Are Mental Health Factors Related?
  55. Adolescent Births in the Border Region: A Descriptive Analysis Based on US Hispanic and Mexican Birth Certificates
  56. Screening Tests during Prenatal Care: Does Practice Follow the Evidence?
  57. The Influence of Pregnancy on Sweet Taste Perception and Plaque Acidogenicity
  58. Sports and Leisure Time Physical Activity During Pregnancy in Nulliparous Women
  59. Access to Patient-Centered Medical Homes in Children with Sickle Cell Disease
  60. Access to Patient-Centered Medical Homes in Children with Sickle Cell Disease

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