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PubMed1995

Promising approaches for adolescent reproductive health service delivery. The role of school-based health centers in a managed care environment.

Within the arena of adolescent health care, the most critical service delivery issue is access to care. Efforts to contain health care expenditures through managed care plans inevitably conflict with efforts to deliver truly comprehensive preventive services to all adolescents. Because of the substantial increase in risk behaviors, prevention efforts require frequent contacts if interventions are to be made before risk behaviors occur or soon after their onset. In addition, yearly screening for all adolescents is likely to identify many teens who could benefit from early interventions. Enabling school-based health centers to provide services in coordination with managed care systems would go far to ensure access to care, as well as appropriate attention to the special needs of adolescents, in a timely and cost-effective way. Furthermore, that access would not be tied solely to the family's choice of provider or to the provider mandated by the adolescent's insurance plan. Underlying any approach to coordination of services, however, is the need for managed care providers to understand and affirm a preventive care investment in young people as a means of reducing health care expenditures, an investment that would pay dividends not only during the adolescent years but into adulthood as well. Whether the willingness exists to make this investment, when the cost savings may not directly accrue to the adolescent's current HMO, presents a conflict between the present interests of the HMO and the future interests of whatever provider the adolescent sees as an adult. As managed care systems are more widely adopted, it will be important to ensure that they adequately incorporate the service delivery components that have been found to be efficacious in serving adolescents. Given the leading role school-based health centers can play in providing preventive health care and health promotion, managed care providers should be encouraged to develop strong partnerships with such centers, so that the dual goals of high-quality care and cost containment can be achieved.

Adolescent↗
PubMed1994

Smoking and reproductive health: cigarette smoking as a risk factor in ectopic pregnancy.

To evaluate the association between ectopic pregnancy (EP) and smoking, a hospital based case-control study was undertaken. Also studied were other potential risk factors namely: PID, undernutrition, blood group 'O', the use of IUD, prior abnormal pregnancies and prior abdominal surgery. The investigation included 72 cases diagnosed at the University of Health Sciences, Kansas City, Missouri from January 1, 1976 through December 31, 1987 and 72 pair-matched controls selected from live-birth deliveries at the same hospital. Univariable McNemar analyses revealed four strong risk factors: having ever smoked (OR = 2.1, p = 0.04), previous EP (OR = 14.3, p = 0.0001), previous fetal loss (OR = 4, p = 0.04) and previous pelvic and abdominal surgery (OR = 6.3 p = 0.0001). A stepwise logistic regression analysis using parity, eversmoking, underweight and PID was performed. Only PID remained strongly associated with EP after the first step (p = 0.009).

Adult↗
PubMedDate not supplied

The effects of economic conditions and access to reproductive health services on state abortion rates and birthrates.

The effects that such factors as wages, welfare policies and access to physicians, family planning clinics and abortion providers have on abortion rates and birthrates are examined in analyses based on 1978-1988 state-level data and longitudinal regression techniques. The incidence of abortion is found to be lower in states where access to providers is reduced and state policies are restrictive. Calculations indicate that decreased access may have accounted for about one-quarter of the 5% decline in abortion rates between 1988 and 1992. In addition, birthrates are elevated where the costs of contraception are higher because access to obstetrician-gynecologists and family planning services is reduced. Economic resources such as higher wages for men and women and generous welfare benefits are significantly and consistently related to increased birthrates; however, even a 10% cut in public assistance benefits would result in only one birth fewer for every 212 women on welfare. Economic factors showed no consistent relationship with abortion rates.

Abortion, Legal↗