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Abortion in the United States, 1977-1978.

There were 1.32 million legal abortions in the United States in 1977 and a projected 1.37 million in 1978, an increase of four percent between 1977 and 1978 compared with one of 12 percent between 1976 and 1977. In 1978, 29 percent of pregnant women chose to terminate their pregnancies by abortion. Almost three percent of U.S. women of reproductive age obtained an abortion in 1978. From 1967 through 1978, approximately six million women obtained almost eight million legal abortions; about one in eight U.S. women of reproductive age has had a legal abortion. The number of hospitals reporting that they provided abortion services dropped slightly from 1,695 in 1976 to 1,661 in 1977, but the number of nonhospital abortion clinics increased from 448 to 522, and the number of physicians who reported performing abortions in their offices grew from 424 to 533. Between 1976 and 1977, the average number of abortions per hospital facility decreased from 246 to 237, while the average number per nonhospital provider increased from 875 to 879. The percentage of abortions performed in hospitals declined from 35 in 1976 to 30 in 1977, while the percentage reported by free-standing clinics increased from 61 to 66; the percentage performed in physicians' offices remained at four. Ninety-five percent of abortions in 1977 occurred in metropolitan areas, where 75 percent of the women in need of abortion services live. In 1977, there were identified abortion providers in only 23 percent of U.S. counties. Nine percent (more than 118,000) of the women who obtained abortions in 1977 had to travel to another state for services, and many traveled to other, often distant, counties in their home states. One in three abortions in 1977 were obtained by teenagers, and three in four were obtained by unmarried women. Twenty-eight percent of the women estimated to be in need of abortion services in 1977, and 26 percent in 1978, were unable to obtain them. In FY 1977, before Hyde amendment restrictions on government financing of abortions for poor women, 133,000 of the estimated 427,000 Medicaid-eligible women in need of publicly funded abortion services were unable to obtain them.(ABSTRACT TRUNCATED AT 400 WORDS)

Abortion, Legal↗
PubMed1977

Control of fraud and abuse in Medicare and Medicaid.

This Comment explores issues concerning the control of fraud and abuse in health programs financed with public funds, specifically the Medicare and Medicaid programs. It summarizes the nature, scope, and possible causes of what some regard as a fraud and abuse "crisis," and points out the difficulties and obstacles facing those who attempt to develop legislative and executive action aimed at controlling fraud and abuse. Recent federal initiatives in fraud and abuse control are examined, and a brief summary of key provisions of H.R. 3 (the Medicare-Medicaid Anti-fraud and Abuse Amendments, which may prove to be a landmark piece of legislation in this area) is provided. The author emphasizes that more effective control of fraud and abuse is necessary if further expansion of government financing of health programs, including national health insurance, is to occur in the near future. At the same time, caution must be taken not to neglect the appropriate use of other mechanisms necessary for reducing the costs of medical care and improving its quality. In addition, it is likely that efforts to stem fraud and abuse will raise important medicolegal and public policy issues that will require careful interdisciplinary consideration.

Crime↗
PubMed1979

Community mental health centers and the "seed money" concept: effects of terminating federal funds.

What happens to community mental health centers when federal funding ends? Analysis of the funding patterns of a cohort of "graduate" community mental health centers indicates that these centers remained fiscally viable subsequent to termination of basic federal grants. However, further analysis revealed two distinct funding patterns within the cohort. One group relied primarily on increased third-party reimbursements to offset the end of basic federal grants. The other sought more state funds and additional federal grants available through the Community Mental Health Center Amendments of 1975. As more centers "graduate," federal "floor funding" may be necessary to insure the survival of some of them.

Community Mental Health Centers↗
PubMed1977

Problems in analyzing the comparative costs of private versus public psychiatric care.

The authors outline the difficulties in attempting to compare the costs of service in various mental health settings, especially private practice and community mental health centers. Contributing to the difficulties are the differences in the populations served, differences in treatment modalities employed, and the different economic incentives operating in each setting. The authors stress the need for research on cost effectiveness as the basis for valid comparisons of various care settings.

Community Mental Health Services↗
PubMed1978

The distributional effects of national health insurance in Quebec.

In November of 1970 a major change in public health policy occurred in Quebec: the movement from a mixed private-public system to a completely public system of financing health care (known as Medicare). This policy change had important economic effects on the distribution of income, taxation, and health care costs. This paper analyzes these economic effects by focusing on the changes in financial burden of medical care costs between 1969-70 and 1971-72 for eight income classes. The key results that emerge are: the total cost of medical care increases sharply for all of the income groups, and the burden of the cost of medical care becomes more equitable across the income groups. Based on these results, policy considerations for the present debate on national health insurance in the United States are offered.

Financing, Government↗
PubMed1979

Response of low income women and abortion facilities to restriction of public funds for abortion: a study of a large metropolitan area.

During the first five months after the restriction of public funds for abortion, a large percentage of low-income women seeking abortions in a metropolitan area in Texas obtained abortion that were partially subsizied using a combination of reduced clinic fees and public funds for ancillary non-abortion services. Their own personal funds made up the difference between the subsidy and the full cost of the procedure.

Abortion, Induced↗
PubMed2026

From spillover to systems: evidence gaps in One Health preparedness for emerging infectious diseases in Latin America and the Caribbean.

Latin America and the Caribbean are a global hotspot for emerging and re-emerging infectious diseases, yet regional One Health preparedness remains uneven and incompletely operationalized. This narrative Mini Review synthesizes evidence published mainly between 2015 and 2026 on One Health preparedness for emerging infectious diseases in the region, emphasizing how environmental disruption and climate change shape zoonotic and vector-borne spillover risk. Available regional surveys suggest broad professional familiarity with the One Health concept but limited operational implementation, with environmental health frequently identified as the least-integrated domain. We argue that spillover risk-and the failure to detect and contain spillover once it occurs-should be understood as a system-level outcome shaped by ecological disruption, socioeconomic vulnerability, surveillance capacity, and governance, rather than as an isolated biological event: deforestation, agricultural and extractive expansion-including illegal mining and logging-unplanned urbanization, and climate variability generate new human-animal-vector interfaces, while fragmented governance, uneven and poorly decentralized laboratory capacity, and limited reservoir and environmental surveillance leave these interfaces unmonitored. Environmental and climatic drivers are robustly linked to spillover, although the pathways are disease-specific rather than universal, and socioeconomic vulnerability concentrates the resulting burden in Indigenous, rural, and marginalized populations. We identify priority gaps in integrated surveillance, decentralized diagnostics, genomic capacity, reservoir ecology, governance, financing, and equity, and propose an agenda for anticipatory, climate-informed, and context-sensitive preparedness.

Latin America↗
PubMed1979

Age differences in health care spending, fiscal year 1977.

This report of health care spending in fiscal year 1977 reveals that of the $142.6 billion spent by the Nation for personal health care in fiscal year 1977, 29 percent was spent for those aged 65 or older, 59 percent for those aged 19-64, and 13 percent for those below age 19. The average health bill reached $1,745 for the aged, $661 for the intermediate age group, and $253 for the young. Public funds financed 67 percent of the health expenses of the aged, with Medicare and Medicaid together accounting for 61 percent. More than two-thirds of the health expenses of the young and 71 percent of the expenses of those aged 19-64 were paid by private sources. Third-party payments met 68 percent of the health expenditures of all those under age 65.

Adult↗