Still Piecing It Together: Women's Primary Care

Abstract

The 20-year anniversary of Women’s Health Issues is an opportune time to consider whether the past two decades have seen substantial progress in improving primary care for American women. At least as early as 1992, when Clancy and Massion (1992) described women’s health care as ‘‘a patchwork quilt with gaps,’’ health services researchers and health care providers have been aware of the unique challenges to providing coordinated, comprehensive, high-quality primary care services to women. One of the major issues is how to integrate and coordinate routine reproductive health services with other components of women’s primary care in a seamless delivery system. This is not a trivial question, because reproductive caredincluding, for example, contraceptive services, pregnancy-related care, infertility services, gynecological care, and gender-specific cancer screeningdis needed by all women at some point in their lives. Despite the fact that women are the majority of health care consumers, this issue has not beenwidely recognized by those promoting ideal conceptions of ‘‘primary care’’ or the newer concept of a ‘‘patient-centered medical home.’’ Have we made any progress at all? Historical patterns of care delivery based on the specialty areas of physicians, as well as on the ways in which health services are funded or reimbursed, have resulted in fragmented primary care for women. Most women have directly experienced fragmentation. Any womanwho has visited her family physician for a regular checkup and then had tomake a separate visit (with another copay) for a routine Pap smear understands that her convenience and needs are not foremost in the design of basic health services. Anywomanwhose obstetrician-gynecologist has told her that she has to go elsewhere for a cholesterol test knows that a reproductive health specialist does not provide comprehensive care. Any womanwho reports symptoms of postpartum depression or consequences of intimate partner violence to her