Evolving Roles for Health Care in Supporting Healthy Child Development

4区 法学 Q1 Social Sciences Future of Children Pub Date : 2020-09-01 DOI:10.1353/foc.2020.a807755
A. Schickedanz, N. Halfon
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引用次数: 4

Abstract

Summary:Health care reaches more children under age three in the United States than any other family-facing system and represents the most common entry point for developmental assessment of and services for children. In this article, Adam Schickedanz and Neal Halfon examine how well the child health care system promotes healthy child development early in life. They also review children’s access to health care through insurance coverage, the health care system’s evolution in response to scientific and technical advances, and the shifting epidemiology of health and developmental risk.The authors find that the health care system is significantly underperforming because it is constrained by antiquated conventions, insufficient resources, and outmoded incentive structures inherent in the traditional medical model that still dominates pediatric care. These structural barriers, organization challenges, and financial constraints limit the system’s ability to adequately recognize, respond to, and, most importantly, prevent adverse developmental outcomes at the population level.To achieve population-level progress in healthy child development, Schickedanz and Halfon argue that pediatric care will need to transform itself and go beyond simply instituting incremental clinical process improvement. This will require taking advantage of opportunities to deliver coordinated services that bridge sectors and focusing not only on reducing developmental risk and responding to established developmental disability but also on optimizing healthy child development before developmental vulnerabilities arise.New imperatives for improved population health, along with the growing recognition among policy makers and practitioners of the social and developmental determinants of health, have driven recent innovations in care models, service coordination, and coverage designs. Yet the available resources and infrastructure are static or shrinking, crowded out by rising overall health care costs and other policy priorities. The authors conclude that child health systems are at a crossroads of conflicting priorities and incentives, and they explore how the health system might successfully respond to this impasse.
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卫生保健在支持儿童健康发展方面不断演变的作用
总结:在美国,医疗保健覆盖了比其他任何面向家庭的系统更多的三岁以下儿童,并且代表了儿童发展评估和服务的最常见切入点。在这篇文章中,Adam Schickedanz和Neal Halfon研究了儿童医疗保健系统如何促进儿童早期健康发展。他们还审查了儿童通过保险获得卫生保健的机会,卫生保健系统为应对科学和技术进步而发生的演变,以及卫生和发育风险流行病学的变化。作者发现,卫生保健系统明显表现不佳,因为它受到过时的惯例、资源不足和传统医疗模式固有的过时的激励结构的限制,而传统医疗模式仍然主导着儿科护理。这些结构性障碍、组织挑战和财政约束限制了该系统充分认识、应对,最重要的是,防止人口水平上不利的发展结果的能力。Schickedanz和Halfon认为,为了在儿童健康发展方面取得人口水平的进步,儿科护理需要自我转变,而不仅仅是建立渐进的临床过程改进。这将需要利用各种机会提供协调一致的服务,将各部门联系起来,不仅注重减少发育风险和应对既定的发育障碍,而且注重在发育脆弱性出现之前优化儿童的健康发展。改善人口健康的新要求,以及决策者和从业人员日益认识到健康的社会和发展决定因素,推动了最近在护理模式、服务协调和覆盖设计方面的创新。然而,可用的资源和基础设施是静止的或正在萎缩,被不断上升的整体医疗保健成本和其他政策重点所排挤。作者得出结论,儿童卫生系统正处于优先事项和激励措施相互冲突的十字路口,他们探讨了卫生系统如何成功应对这一僵局。
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Future of Children
Future of Children Multiple-
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期刊介绍: The Future of Children is a collaboration of the Woodrow Wilson School of Public and International Affairs at Princeton University and the Brookings Institution. The mission of The Future of Children is to translate the best social science research about children and youth into information that is useful to policymakers, practitioners, grant-makers, advocates, the media, and students of public policy. The project publishes two journals and policy briefs each year, and provides various short summaries of our work. Topics range widely -- from income policy to family issues to education and health – with children’s policy as the unifying element. The senior editorial team is diverse, representing two institutions and multiple disciplines.
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