PubMed · 2712928
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J D Blanco. 1989. Planning a maternal-fetal medicine program. The private practice model.. https://pubmed.ncbi.nlm.nih.gov/2712928/
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Health care can be funded in a number of ways ranging from direct user charges (out of pocket) payments to indirect methods that pool across time (prepayment) and across different risk and wealth groups (insurance and general taxation). All these methods can be used to finance maternal health services. When assessing the impact of financing mechanisms it is important to be aware of the different ways they effect service delivery patterns and utilisation. Specifically most systems have both equity and efficiency aspects that combine to impact on health service utilisation and health status. In general indirect methods that help families to pool the costs of maternal health services are preferable to direct methods of payment. It is also clear, however, that user charges may sometimes help to mitigate deficiencies in systems of pooled funding. Available literature suggests that financing mechanisms for maternal health services could be improved by systems that increase transparency, help to mitigate demand-side costs of services and provide funding for that promote transparent charging for services. While the limited experience of demand-side mechanisms for improving access to maternal health services more evaluation is required.
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Communities requiring the services of a maternal-fetal medicine person will need to provide an environment in which the subspecialist is seen as an adjunctive help and improvement to that community. The perception of competitiveness among the obstetric and gynecologic community will need to be avoided and careful consideration given to the type of practice that the perinatologist will develop and the inability of some subspecialists in this field to derive a proportion of their income from the more elective aspects of obstetrics and gynecology normally opened to physicians practicing general obstetrics and gynecology.