Can the practicing pediatrician provide comprehensive health care for the multiply handicapped child?
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The evidence is substantial that comprehensive, HMO-type prepayment plans can significiantly reduce hospitalization rates. Yet it remains unclear which factors contribute to this phenomenon. This study focuses on organizational characteristics of four plans with different hospitalization experiences. Regular medical staff review and frequent use of second opinions and economies of scale achieved by providing care at one well-equipped, large health center appear to have the largest impact. However, such organizational advantages can easily be wiped out by adverse self-selection of patients during open-enrollment periods. Evidence of selection based on predictable high obstetrical and newborn care costs is presented.
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Homeless women who are pregnant present a number of challenge to health care providers. As a group, they are at risk for a variety of illnesses that could affect their pregnancies, including sexually transmitted diseases and substance abuse. Poor access to health care, inadequate prenatal care, poor nutrition, and poor housing cause these women to suffer poor birth outcomes. They are more likely to deliver low birth weight infants and have higher rates of infant mortality. It should be understood that homeless pregnant women are a heterogenous group. Generally, they are pregnant adolescents and women in homeless families. Additionally, there are differences within these two groups. The causes of homelessness for these women vary as do their needs during pregnancy. Any provider of health care to the homeless must understand the different situations of these women to deliver directed, effective care.
More than half the poor are not covered by Medicaid, the program designed to serve them. Louise Russell outlines a program that would make health care available to all of the poor.
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