Women's health activists believe that health plans should have the following features in order to meet our needs as women:

• 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 time.
• access to midlevel practitioners (midwives, nurses) and other health practitioners of our choice--not just doctors.
• access to trained doctors and nurses in times of crisis, and especially during hospitalization.
• 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 home.
• choice of providers.
• global budgeting* for hospitals and other institutions to control costs fairly.
• 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 the home).
• more training, upgrading, and pay equity for nonphysician women health workers.
• better-quality, unbiased women's health information.
• 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 p. 693).
• 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 caregiving.
• better technology assessment and evaluation research, with results publicly available. (See box, ``Evidence-Based Practice and the Cochrane Collaboration,'' p. 710.)
• mechanisms for national health planning (such as existed in the 1970s).
• 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 existing drugs.
• 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.

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