Health Care Services For Women Research Articles

Planning for women's health care services

Managed care organizations have an opportunity and an obligation to provide comprehensive health care services to women. The opportunity arises from the nature of the health insurance arrangements linking a woman, by contract, to one insurer for all her health care needs. As the sole-source provider for care, the managed care organization has the opportunity to plan for and to coordinate the implementation of the complete array of needed and desired services for women of all age groups. With this opportunity comes the obligation to try to provide not only what is medically appropriate but also what is preferred. In order to plan for needed health care services, our organizationHarvard Community Health Plan-used a process for clinical program planning. Harvard Community Health Plan (HCHP) is a mixed model, nonprofit health maintenance organization (HMO) in New England, with a membership of more than 500,000. (At the time of this publication, a merger with Pilgrim, a New England-based independent practice association [IPA] model HMO, will be in process, resulting in an organization of more than l,OOO,OOO members named Harvard Pilgrim Health Care). Clinical program planning uses population-based approaches to guide the identification of improvement initiatives, focusing on best opportunities to improve clinical outcomes, customer satisfaction, and costs. This approach is being adopted increasingly by the larger, mature managed care organizations, with some early successes.1’2 Improvements are achieved through identifying and implementing optimal care processes and essential support programs. Measurement of key outcomes and overall program evaluation allows for assessment of effectiveness of current program and for identification of future opportunities. The vehicle used to oversee this process in our organization has been the development of steering committees, consisting of clinical leaders and managers from the various divisions of the organization. Steering committees have been established for the initial priority clinical areas of the organization: asthma, diabetes, pediatric prevention, mental health and substance abuse, and women’s health. The Women’s Health Steering Committee has met bimonthly over the past year with the goal of developing a mix of strategies to yield short-term, mid-term, and long-term improvements in health care for women.

Self care actions of Colombian por día domestic workers: on prevention and care.

This is a report of a phenomenological study of Colombia's "por día" domestic workers that examined their actions in promoting their health, in preventing illnesses, and in caring for themselves. A cross sectional sample of 60 per diem female domestic workers in one large city in Colombia were interviewed using open-ended interview questions about their health, self-care actions, health care resources, and patterns of utilization. We argue that knowledge of women's experiences with the health care system, their knowledge of their bodies, and the daily demands on their time and life are vital in defining and planning health care services that women need. We demonstrated that the structural conditions in and for health care services and the lack of knowledge of their bodies act as barriers to women's utilization of health care services and to maintaining their health. Our findings support the need for considering women's health from a development perspective and for offering more integrated and cohesive health care services for women.

Primary health care for women: What is it and who provides it?

Recent federal policy has highlighted historically underrecognized women's health issues. Women comprise the majority of the population, especially the elderly. Women's health care needs, utilization patterns, and outcomes vary from those of men, and often among each other. Primary health care services for women are multidisciplinary and emphasize prevention, education, and early intervention as well as treatment. Psychologists and other primary health care providers can collaborate to provide their services in a cost-effective manner that optimizes quality of care and comprehensive health care.

Factors Hindering Access to Abortion Services

Although abortion services are readily available in large urban areas to those able to pay, a 1993 survey of U.S. abortion providers shows that access to service is still problematic for many women because of barriers related to distance, gestation limits, costs and harassment. Among women who have nonhospital abortions, an estimated 24% travel at least 50 miles from their home to the abortion facility. Although 98% of providers will perform abortions at eight weeks after the last menstrual period, only 48% will perform abortions at 13 weeks and 13% at 21 weeks. Half of nonhospital abortion providers estimate that more than four days elapse on average between their patients' first telephone contact and the date of the procedure; one in seven say that more than one week elapses. Most women are able to obtain abortion services in one visit to a clinic. The average woman having a first-trimester nonhospital abortion with local anesthesia paid $296 for the procedure in 1993, up from $251 in 1989. On average, nonhospital facilities charged $604 at 16 weeks of gestation and $1,067 at 20 weeks. Eighty-six percent of nonhospital facilities providing 400 or more abortions in 1992 were the targets of antiabortion harassment. Picketing at facilities and the homes of staff members, vandalism and chemical attacks increased significantly between 1988 and 1992, but the incidence of bomb threats decreased.

Issues in health care services for women

This article reviews the insufficient nature of womens health programs in developing countries and presents a new approach the Program of Integral Assistance to Womans Health (PIAWH) which was implemented in Sao Paulo Brazil during 1987-91. Most maternal and child health programs have been aimed at enhancing the health of the child or at solving demographic problems. Even the Safe Motherhood Initiative was limited to reproductive life (and usually further limited to pregnancy and delivery). The contraceptive coverage in most Latin American countries has the nature of a fertility control program depending largely on tubal ligations rather than that of a family planning program. The leading causes of death (heart disease infections respiratory diseases cancer and accidents) are ignored in a concern over maternal mortality. In addition women often have to make 3 trips to a primary health care center to have a single complaint addressed. This situation led to the PIAWH which offers a full range of integrated activities to attend to womens needs as well as preventive programs. The PIAWH objectives were 1) to reduce maternal and perinatal mortality; 2) to control cervical and breast cancers; 3) to transform the fertility control program into a family planning service; and 4) to improve prevention and control of sexually transmitted diseases and chronic disorders such as diabetes and hypertension. Special programs were also organized for adolescents and menopausal women. The PIAWH resulted in an increase in contraceptive coverage and a decrease in womens morbidity and mortality. This will lead to the development of a program of comprehensive health care which will improve the quality of life for women.

Children and pregnant women.

A review of the literature of the 1980s reveals that women living in rural American are at risk for receiving inadequate prenatal and maternal care. Documented risk factors include poverty and concomitant lack of medical insurance, residence in the most restrictive Medicaid states, and loss of local services including the closure of obstetric units of rural hospitals and the decision by local physicians to discontinue obstetrics. A prominent factor in a physician's decision to stop providing maternity care is the escalating cost of medical liability insurance; however, other forces are also at work, including interference with personal and family activities, disruption of other aspects of professional life (e.g., office schedule), inadequate reimbursement, and an inability to keep up with advancing technology. A research agenda for the 1990s should be consistent with previous recommendations and must stimulate the development of new programs that will induce the maximum number of providers to again offer high quality perinatal care to rural women. Other items on the 1990s research agenda include: (1) the clarification of the impact of lost perinatal services in rural areas, (2) the effects of travel time and distance on perinatal outcomes and cost of care, (3) the effect of loss of obstetric services on other health care services for women and children, and (4) comparisons of regionalized versus centralized systems for the provision of perinatal services.

Attributes and perceived benefits of women's health care services.

To protect against declining admission rates and revenues, many hospitals are introducing innovative services to attract patients and physicians to their facilities. Women's health programs have been developed and offered in many markets consistent with this need. This paper examines the actions that hospitals have taken to date, and compares them to the attributes that have been cited in the literature that are seen to influence patient choice. The paper provides a framework which can be used to more effectively define and target programs of this type.