following is an exclusive excerpt
from the "Politics" chapter of Our
Bodies, Ourselves for the New Century.
For complete information and resources,
we recommend that you consult the
chapter and the book in its entirety.
REFORMS NEEDED TO MEET WOMEN'S
Women's health activists believe
that health plans should have the
following features in order to meet
our needs as women:
Many women are also calling for broader
reforms in the U.S. health and social
service systems, such as
- benefit packages and insurance
systems that are not linked to welfare,
employment, income, or health status.
- comprehensive benefits: reproductive/gynecological/child-bearing,
occupational/ environmental, mental,
dental, long-term care.
- an emphasis on genuine primary
care for women--readily accessible,
coordinated care that emphasizes
prevention and is based on ongoing
relationships with providers over
- access to midlevel practitioners
(midwives, nurses) and other health
practitioners of our choice--not
- access to trained doctors and
nurses in times of crisis, and especially
- full coverage of illness care,
without penalties or cancellations.
full coverage of home dialysis,
homedbirth, hospice care, and the
specialdtreatment needs of HIV-positive
anddsubstance-abusing pregnant women.
- long-term care, rehabilitation
and disability services.
- coverage of all necessary drugs.
- confidentiality of medical records
and protection from genetic discrimination
(see p. 717).
- specific mechanisms of accountability
and evaluation that are clear to
all parties and are binding on the
caregiving system, so that users
have a basis and right of redress
when providers fail to meet obligations.
- just compensation or redress when
the system fails or damages us.
- community-based services near
- choice of providers.
- global budgeting* for hospitals
and other institutions to control
- an independent advocate (ombudsprogram)
to guarantee fair adjudication of
complaints and claims.
- recognition of women's unpaid
labor as health workers in community,
family, and home (via income-tax
credits or Social Security credits,
and respite services that give time
off for full-time caregivers in
- more training, upgrading, and
pay equity for nonphysician women
- better-quality, unbiased women's
- consumer- and community-based
research on appropriate elements
of primary care for women.
- recognition of patients', consumers',
and the community's rights and roles,
especially women's, in system planning
and policy decision-making and governance.
- elimination of all existing insurance
discrimination against women.
- a single-payer system that would
provide universal access and equity
by eliminating profits and administrative
waste through public control (see
- rigorous elimination of waste
and fraud, and limits on excess
administrative activity such as
advertising and marketing.
- the training and retraining of
health professionals in the economic/cultural/
psychological and race/gender/age
determinants of health and effective
- better technology assessment and
evaluation research, with results
publicly available. (See box, ``Evidence-Based
Practice and the Cochrane Collaboration,''
- mechanisms for national health
planning (such as existed in the
- clinical practice standards, with
input and review by consumers/patients.
- controls on the drug industry
to reduce exorbitant prices and
focus research on new treatments
instead of profitable copies of
- improved investment in and recognition
of public health programs.
- better monitoring of the health
status, needs of and services for
vulnerable populations (young, elderly,
those with disabilities, AIDS, etc.)
in managed care programs.
- public policies that establish
an individual's right of ownership
over her or his genetic material
as well as control over who has
access to her or his genetic information.
*Global budgeting is any annual,
government-established target or spending
limit for health expenditures. In
other countries, it has been used
to control wasteful expansion of already
half-empty facilities and duplication
of high-tech services such as CAT
scanners by hospitals competing for
doctors and patients. In its most
extreme form, annual limits that are
too stringent would be set for health
care expenditures, as several states
are now preparing to do in response
to welfare reform.
To have some control over our lives
and to be informed participants in
our health and medical care, we need
a lot of information about our bodies
and about the health system. We need
to know what options are available.
We need to know which forms of care
have not been adequately studied-
-and are therefore ``experimental''--and
which forms of care have been adequately
studied and have been shown to be
either effective or ineffective or
even harmful. We need to know the
risks that are involved with each
choice. Knowledge gives us the ability
to make choices.
Copyright © 1984, 1992, 1998 by the
Boston Women's Health Book Collective.
All rights reserved. Published by
Touchstone, a division of Simon
& Schuster Inc.
order Our Bodies, Ourselves for
the New Century