FCRP Policy Statement

Primary care and prevention of disease should be the focus of a reformed health care system, according to the members of the American Nurse Association (ANA) who testified before the Subcommittee on Aging, Senate Labor and Human Resources Committee in March 1994. Speaking as both health care providers and women (97 % of the United States' two million nurses are female), the ANA offered the following assessment of the current status of women in the health care system mid recommendations for reform.

The ANA states that many of the problems of the current health care system disproportionately effect women, including:

Lack of comprehensive benefits: Many insurance programs, including Medicare, do not adequately address women's preventive care needs (i.e. breast and cervical cancer screening). Minority women are especially, affected-57% of black and Hispanic women do not receive preventive health care.

Limited access to health insurance: Twelve million women have no health insurance of any kind and millions more have' inadequate insurance. Poor and near poor women are the least likely individuals to have health insurance. Women are less likely than men to receive health insurance through employment. 60% of men have job-related health insurance, compared to only 37% of women. In addition, women have higher out-of-pocket costs for health care, due to their greater use of reproductive and preventive health-care services. Women account for 69 % of the over 10 million Americans who spend more than, 10% of their income on health care costs. This figure includes over 5 million women with private insurance.
Limitations on access to a full range of health care providers: The ability of nurses to provide health care services has continually been hampered by a number of artificial barriers. Artificially depressed wages, lack of third party reimbursement policies by federal and state programs and private insurers, limitations of state nurse practice. acts, and the unavailability of malpractice insurance have had a major negative impact on the ability of advanced practice nurses to utilize their education and training. In addition, these barriers place an undue burden on women who receive, or would prefer to receive, their care from an advanced practice nurse.

Gaps in knowledge in women's health research: Scientific research continues to be needed in every aspect of women's health throughout their biological lives-from infancy through the later years. Significant information about women in specific disease areas continue to be lacking despite recent Congressional efforts to increase funding for federally sponsored research programs and mandating the inclusion of women in clinical trials. Minority women, many of whom are vulnerable to high blood pressure, strokes, and HIV disease, have been especially neglected. In addition, there is an overall male-bias in treatment from the health care system. For example, data demonstrates that when a women with a heart attack is admitted to the emergency department she is less likely to receive aggressive treatment than a man admitted with similar symptoms.

POLICY IMPLICATIONS

• Health care reform can address these issues by:
• Providing equal access to health insurance to all.
• Controlling out-of-pocket costs by, abolishing co-payments for preventive care services.
• Maintaining the health care benefits provided under the current Medicaid system.
• Ensuring that women have access to health services by maximizing the delivery of primary and preventive health care in convenient, community-based settings such as at the workplace, schools, day care centers and in the home.
• Giving patients the option of receiving care from the health care provider of their choice.
• Ensuring that all individuals have access to comprehensive health benefits.
• Creating a health care system that treats women as equals.

From "Women's Health Provisions in Health Cam Reform," Testimony of the American, Nurses Association, American Association of Critical Cam Nurses and the National Nurse Practitioner Coalition before the Subcommittee on Aging, Senate Labor and Human Resources Committee, March 9, 1994. Supported by Grant No. IROICA56638 from The National Cancer Institute, "Rural Partnership Linkage for Cancer Cam," a Cooperative effort of the Michigan State University Colleges of Nursing and Human Medicine, Department of Family Practice, the Cancer Center at MSU, the West Michigan Cancer Center, and the MSU/Kalamazoo Center for Medical Studies. ks: 159::policy.oct 9/26/94