Help for infants and pregnant women - delivery system programs

USA Today (Society for the Advancement of Education), April, 1993

Each year, 39,000 American infants die before their first birthdays, giving the U.S. one of the highest infant mortality rates among industrialized countries. Contributing to these deaths is the fact that many children and pregnant women fail to receive basic health services. Yet, according to Joshua Wiener, a senior fellow in the Brookings Economic Studies Program, and Jeannie Engel, a consultant with the Management Assistance Group, authors of Improving Access to Health Services for Children and Pregnant Women, "Where there is agreement that action is necessary, there is not a clear consensus on what should be done."

The national rate of low birth weight, the factor most associated with infant mortality, has remained virtually unchanged over the last decade. Though the death rate of infants has declined in recent years, that is largely the result of high-technology medicine. Little progress was made in the 1980s in getting women into prenatal care in the earliest stages of pregnancy, which can reduce incidence of low birth weights.

Despite the availability of a myriad of services, poor women and children may face obstacles to health care. The AIDS epidemic, drug abuse, homelessness, and other social problems have made these barriers even more complicated than in the past.

Smoking and drug abuse lower infants' birth weights. Large numbers of unintended pregnancies--79% of births to young mothers aged 15-19--also affect the survival of babies. In inner cities, food from chain restaurants and convenience stores must substitute for healthier goods available in suburban grocery stores. At the same time, more demands have been placed on government budgets. General disagreement prevails over whether the role for Federal, state, or local authorities in providing health care should be increased.

Much of the current debate revolves around financing approaches, such as Medicaid and private insurance. Eligibility requirements for Medicaid could be lowered in order to cover more of the poor. Or individuals who might not otherwise be eligible for it could pay for part of their coverage in order to provide more of the needy with health services.

Changes in financing approaches, however, may not resolve some obstacles to health care. Many inner cities and rural areas lack physicians or other health care professionals to provide care. Difficulties with lack of coordination between services, transportation, child care, language barriers, and inconvenient hours may prevent women from obtaining assistance, as may personal or cultural characteristics or values.

Though only a small part of the nation's health care system, delivery system programs have the ability to overcome these barriers and have played an important part in providing health care to the nation's poor. The Community and Migrant Health Center program, for example, has established 600 health centers serving more than 5,500,000 poor people. Other delivery systems include the National Health Services Corps, maternal and child health block grant program, Title X family-planning program, and special supplemental program for women, infants, and children (WIC). Local programs include health departments, public hospitals, voluntary organizations, and school-based projects.

"Despite positive results, funding for these programs has not kept pace with the need and has not matched the increases in the Medicaid program," Wiener and Engel note. The National Health Service Corps, for instance, placed 1,600 physicians, nurses, and other health-care professionals in underserved areas across the country in 1985, but cuts in funding had reduced that number to 215 by 1989. "A Medicaid or insurance card may not give a person access to services. By placing health care providers in these underserved areas, delivery system programs seek to directly counter this problem."

Both financing and delivery approaches are necessary and interdependent in improving health. "But virtually all of them face enormous barriers to implementation, principally lack of funding. ... The key question is whether we, as a society, have the political will to reorder our priorities and make the health of future generations a vital concern."