La matrona y el Seguro de Maternidad durante la Segunda República (1931-1936) / The midwives and the Maternity Insurance during the Spanish Second Republic (1931-1936)

El objetivo del presente trabajo es analizar el importante papel que la matrona tuvo en la puesta en marcha y evolución posterior del Seguro de Maternidad durante la Segunda República y que ha sido ignorado por otros estudios.Metodología: Investigación histórica que emplea como fuentes primarias toda la documentación producida por el Instituto Nacional de Previsión, así como la obtenida en diferentes archivos nacionales.Resultados: El Seguro de Maternidad confirió gran protagonismo a la matrona en el seguimiento del embarazo y la atención al parto y al posparto de las mujeres trabajadoras. Al menos 2.223 matronas colaboraron con el Seguro durante los 9 primeros trimestres de funcionamiento de éste.Conclusiones: El Seguro de Maternidad no se limitó a la mejora de la salud materna mediante el control del embarazo y la asistencia profesional al parto y al posparto, sino que también se ocupó de las enfermedades del bebé durante los 6 primeros meses de vida. Su puesta en marcha supuso una importante fuente de oportunidades de trabajo y de ingresos para las matronas durante la Segunda República. También influyó en la progresiva institucionalización del parto que tuvo lugar durante el siglo xx. Esta integración en estructuras hospitalarias, fuertemente jerarquizadas, contribuyó a la progresiva subordinación de la matrona a la figura del médico en la atención al parto normal. (AU)

The aim of this report is to examine the important role played by midwives in the beginning and subsequent evolution of Maternity Insurance during the Spanish Second Republic that has been forgotten by other studies.Methodology: Historical research which uses primary sources such as all of the documentation produced by the Instituto Nacional de Previsión and other files obtained from various national archives.Results: Maternity Insurance granted a prominent role to midwives in prenatal care, delivery care and postnatal care of women workers. It’s estimated that at least 2,223 midwives collaborated with the Insurance program during the first 9 trimesters of its functioning.Conclusions: Maternity Insurance wasn’t limited to the improvement of the mothers’ health by monitoring them throughout pregnancy and by providing professional attendance at birth and postpartum care, but it also provided newborn care for the infants’ first 6 months of life. The beginning of the program opened up an important source of work opportunities and an increase of wages for midwives during the Second Republic. It also influenced in the progressive institutionalization of childbirth during the 20th century. The integration in the hospital structure, which was strongly hierarchic, contributed to the progressive sub- ordination of the midwife under the doctor during normal birth. (AU)

Fertility-a human right worthy of mandated insurance coverage: the evolution, limitations, and future of access to care.

We review the history, current status, and potential future of state infertility mandates and focus on the business implications of mandates and on the inadequacies and reproductive injustice resulting from gaps between legislative intent and practical implementation. Nineteen states have passed laws that require insurers to either cover or offer coverage for infertility diagnoses and treatment. The qualifications for coverage, extent of coverage, and exemptions vary drastically from one state to another, resulting in deficiencies in access to care even within mandated states for certain groups, such as single individuals, patients in same-sex relationships, and patients pursuing fertility preservation. Although insurance coverage of fertility services in the United States has expanded as an increasing number of states have enacted infertility mandates, significant gaps in implementation and access remain even among states with existing mandates. Provider, patient, and legislative advocacy is warranted in the name of reproductive justice to expand insurance coverage and, in turn, maximize reproductive outcomes, which have been shown to improve as financial barriers are lifted.

Historia de una infraestructura menguante: la crisis terminal del hospital rural al final del franquismo (1960-1975) / History of a dwindling infrastructure: the terminal crisis of the rural hospital at the end of Francoism (1960-1975)

Este artículo analiza la evolución de los hospitales rurales en España entre la segunda mitad del siglo XVIII y el final de la dictadura franquista, las décadas del «desarrollismo». En su primera parte explica las características de los hospitales rurales de aldeas y villas y las causas de su declive durante el siglo XIX en beneficio de los hospitales provinciales. Así mismo, el texto se aproxima a las condiciones de ejercicio de la medicina rural a lo largo del siglo XIX y las primeras décadas del XX (hasta la Guerra civil). En su segunda mitad, a partir del análisis de los Catálogos de hospitales correspondientes a los años 1963 y 1970, el artículo dibuja una panorámica de la asistencia hospitalaria en el mundo rural al final de la dictadura, pero aten-diendo también a las dinámicas específicas de cuatro regiones y a sus contrastes: Galicia, el País Vasco, La Mancha y Andalucía. Para una población, la rural, que fue la mayoritaria en España hasta entrada la segunda mitad del siglo XX, las décadas finales de la dictadura supusieron el tránsito definitivo de un modelo de asistencia sanitaria rural basado en la medicina liberal y en la beneficencia (pública y privada) a otro de medicina socializada y localización urbana (AU)

Political Accommodations in Multipayer Health Care Systems: Implications for the United States.

Current interest in a single-payer approach to universal health care coverage in the United States has also triggered interest in alternative multipayer approaches to the same goal.An analysis of experiences in Germany, the Netherlands, Switzerland, and Israel shows how the founding of each system required a distinctive political settlement and how the subsequent timing, content, and course of the reforms were shaped by political circumstances and adjustments to the founding bargain in each nation.Although none of these systems is directly transferable to the United States, certain parallels with the American context suggest that a multipayer approach might offer a model for universal coverage that is more politically feasible than a single-payer scheme but also that issues associated with risk selection and other potential inequities would remain.

Legal and policy requirements of basic health insurance package to achieve universal health coverage in a developing country.

OBJECTIVES: This study has analyzed the policy-making requirements related to basic health insurance package at the national level with a systematic view. RESULTS: All the documents presented since the enactment of universal health insurance in Iran from 1994 to 2017 were included applying Scott method for assuring meaningfulness, authenticity, credibility and representativeness. Then, content analysis was conducted applying MAXQDA10. The legal and policy requirements related to basic health insurance package were summarized into three main themes and 11 subthemes. The main themes include three kinds of requirements at three level of third party insurer, health care provider and citizen/population that contains 5 (financing insurance package, organizational structure, tariffing and purchasing the benefit packages and integration of policies and precedents), 4 (determining the necessities, provision of services, rules relating to implementation and covered services) and 2 (expanded coverage of population and insurance premiums) sub themes respectively. According to the results, Iranian policy makers should notice three axes of third party insurers, health providers and population of the country to prepare an appropriate basic benefit package based on local needs for all the people that can access with no financial barriers in order to be sure of achieving UHC.

California's Efforts To Cover The Uninsured: Successes, Building Blocks, And Challenges.

During the last century, California policy makers tried multiple approaches to achieve the goal of affordable health coverage for all: employer and individual requirements, single payer, and hybrids. All failed, primarily because of the amount of financing needed to cover the large numbers of uninsured Californians and the supermajority vote requirements for tax increases. These failures, however, provided important lessons for state and national reform efforts. More immediate success was achieved with incremental reforms, such as child health insurance, Medicaid section 1115 waivers, and the creation of purchasing pools. These reforms, as well as the experience derived from the broader coverage expansion efforts, contributed to the intellectual and policy frameworks that underlay major national reforms and created building blocks for the state's successful implementation of the Affordable Care Act. That act allowed California to meet its greatest need: the financing required to make a truly sizable dent in the numbers of uninsured Californians.

Impact of tobacco industry and other corporations in the defeat of the 1994 Clinton health care plan.

BACKGROUND: The primary reason cited by many scholars for the defeat of the Clinton Administration's 1994 health care reform bill has long been identified as Health Insurance Association of America and National Federation of Independent Businesses opposition to the bill. Given this predominant consensus combined with sizeable proposed funding for the bill by a large tobacco product tax, this manuscript examined what the tobacco industry's role was in whole or part in defeating the Clinton health care bill. METHODS: This research occurred through crosschecking internal tobacco industry documents and Clinton White House documents. RESULTS: Prior to the passage of the bill, the tobacco industry accepted a compromise of 45 cents per pack increase phased in over five years. Due to this compromise, the industry or third party allies had no role in the ultimate defeat in the bill. CONCLUSIONS: The primary reason for the bill's ultimate defeat was general business (but not tobacco industry and third party ally) opposition, the bill running out of time, and conflicting bills. Secondary reasons for the bill's defeat included issues with: employer mandates, high taxes on insurance plans, impacts on medical research and education, Congressional attention to other issues, election year politics, and possible future excise tax possibilities.

La extension del seguro de salud en Iberoamérica: una estrategia de política exterior del franquismo en la inmediata posguerra (1942-1959) / The expansión of health insurance in Latin America: a foreign policy strategy of the franco regime in the post-civil war perior (1942-1959)

La dictadura franquista por motivos de estrategia política intentó influir en materia de seguros sociales, en especial en la cobertura de la enfermedad, en los países iberoamericanos durante las décadas de 1940 y 1950. Los resultados de esta colaboración resultaron mediocres en la práctica y produjeron pocos avances reales, al margen de la imitación de las instituciones de gestión y algunos cursos de formación actuarial y estadística. Este fracaso se debió en gran medida al propio atraso y debilidad del modelo de cobertura sanitaria de la dictadura franquista ahogado por un déficit financiero crónico y con graves limitaciones tanto en la cobertura de la población como en las prestaciones ofrecidas. A partir de la década de 1960, una vez superada la etapa de aislamiento y autarquía, las autoridades franquistas redujeron su interés en la estrategia iberoamericana y comenzaron a mirar a Europa (AU)

For reasons of political strategy, the Franco dictatorship sought to have an influence in matters of social insurance, especially sickness coverage, in Latin American countries during the 1940s and 1950s. The results of this collaboration were mediocre in practice and led to little real progress, apart from imitating management institutions and some actuarial and statistical training courses. This failure was due to a large extent to the backwardness and weakness of the Franco dictatorship’s own model of health care provision, stifled by a chronic financial deficit and with serious shortcomings in both coverage of the population and provisions offered. Beginning in the 1960s, once the stage of isolation and autarky was overcome, the Francoist authorities reduced their interest in the Latin American strategy and started to look towards Europe (AU)

Comprehensive Legislative Reform to Protect the Integrity of the 340B Drug Discount Program.

The 40B Drug Discount Program (340B Program) is a federally facilitated program that requires drug manufacturers to provide steep discounts on outpatient prescription drugs to qualifying safety net health care providers. The federal program is intended as a safeguard to ensure access to affordable drugs to the indigeut. However, over the last two decades safety net health care providers have exploited financial incentives under the 340B Program at the expense of drug manufacturers and patients, including the most needy and vulnerable populations-they are committed to serve. Although the federal government has been applauded for increasing effortsto combat health care fraud and abuse including recovering $3.3 billion in 2014, federal officials and the general public have paid markedly less attention to pervasive abuse of the 340B Program. In 2014, drug purchases of 340B-designated drugs totaled $7 billion and are expected to increase to $12 billion: by 2016 as a result of the expansion of the program under the Affordable Care Act. The 340B Program has completely lost its way, and comprehensive legislation is necessary to realign the program with its intent.

Marking time in the land of plenty: reflections on mental health in the United States.

This reprinted article originally appeared in American Journal of Orthopsychiatry, 1981, Vol. 51, No. 3, 391-402. (The following abstract of the original article appeared in record 2013-42918-004.) This article focuses on reflections on mental health in the United States. This accumulation of wisdom and knowledge from experts inside and outside government has for the most part been ignored or shelved over the years because of revisions, deferrals, impoundments, vetoes, threatened vetoes, reorganizations, budget cuts, inflation, and military demands. Programs such as Head Start, which have been proven successful, have been fighting for survival, and community mental health centers, which in many ways represented a bold, new approach with much creative promise, were threatened with the loss of federal funding in the early 1970s. The humanist tradition in mental health and social services is best exemplified by Pinel's unchaining of psychotic patients: Itards infinite patience in working with Victor, the wild child: and Jane Addams's extraordinary development of community programs. On an international level a recent report of the WHO European Regional Office also has called for a wide ranging, independent group that would cut across national governments and exercise influence at high political levels to insure that important mental health policies are implemented. Perhaps the day will even come when an American President will feel responsible and accountable to the nation in an annual report to Congress and the people on the progress made in health and social welfare areas in his or her administration.