Who will provide preventive services? The changing relationships between medical care systems and public health agencies in health care reform.
Health care reform in the United States will likely attempt to expand the health insurance coverage to uninsured groups, control costs, enhance quality, and expand access to care. Preventive services will be assigned to the medical care system, while new roles and responsibilities will be defined for public health agencies. The clinical preventive services likely required are examined in a population of 44,565 persons residing in Otsego County, New York. Expansion of preventive services to Medicaid requests and the uninsured will require considerable resource expenditure to correct the current deficit in preventive services received by these groups. Moreover, the uninsured and Medicaid recipients have high levels of risk behaviors, identifying a need for health education services effective to that population subgroup. The transfer of responsibilities for clinical preventive services to the medical care system may free up resources for public health agencies to focus on other initiatives such as disease surveillance, health education, and quality assurance. New interrelationships, some cooperative and some adversarial, are likely to emerge, due to a closer working relationship between the medical care system and public health agencies than previously seen in American health care.
Pearson
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Mary Imogene Bassett Research Institute, Cooperstown, New York, USA.
Spencer
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Jenkins
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D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D018166:Health Care Reform; D006801:Humans; D008297:Male; D009518:New York; D011314:Preventive Health Services / Q000458:organization & administration*; D011634:Public Health; D011795:Surveys and Questionnaires; D014481:United States