Ways and Means of Providing Primary and Preventive Health Services

167 Presentation WAYS AND MEANS OF PROVIDING PRIMARY AND PREVENTIVE HEALTH SERVICES PHILIP J. PORTER, M.D. Director Healthy Children Program Division of Health Policy Research and Education Harvard University 68 Harvard Street Brookline, Massachusetts 02146 During THE last eight years, I have had the opportunity as Director of the Healthy Children Program to be involved in the development of community -based programs that address the critical issues of access to and cost of health care. This program is a social marketing effort aimed at transferring existing information to community leaders and then giving ongoing assistance to them as they develop their own response to a particular demonstrated need. During these years, I have been involved with over 100 communities. Fifty have developed new initiatives for children. What the Healthy Children Program has demonstrated is that cost-effective models for accessible health care exist and that the communication of these ideas both speeds up replication and generates new ideas.1 These communities span the country from New England to the Pacific Northwest. Programs exist in cities as populous as Chicago, Ulinois and as rural as Homerville, Georgia. Each is unique because every community has its own resources, its own constraints, and its own political realities. Program design varies greatly and includes ideas such as independent taxing districts for children, public/private partnerships for maternal and child health care, school-based programs for comprehensive adolescent services, and managed home health care for handicapped children. Each program comes with an extraordinary story. I will relate three examples. Journal of Health Care for the Poor and Underserved, Vol. 2, No. 1, Summer 1991 168________Providing Primary and Preventive Health Services Children's referendum In West Palm Beach, Florida, a mother of two decided to become a lobbyist and went to Tallahassee during the 1986 legislative session. Her mission was to convince the legislature to pass a bill allowing every county in Florida to put on the ballot a referendum for children just as the legislature had done in 1945 for the county of Pinellas. She met with constant discouragement. She was told repeatedly to go home and take care of her family. She refused. When the vote on this particular bill came at the very end of the legislative session, it was 99 in favor, one opposed. She went home happy and exhausted. She was not too exhausted, however, to begin planning for the fall election. She carefully assembled an election committee to run a referendum campaign with children as the candidate. This campaign was well organized and well financed. It had the strong support of many local organizations including the Chamber of Commerce. The proponents of the referendum stressed that nothing was being done to address local issues that many agreed were clear problems. They went on to argue that local initiative was essential if tangible improvement was to occur. In November 1986, a referendum creating a Children's Services Council (CSC) financed by anadvalorem property tax passed with 70 percent of the votes cast. In November 1989, the CSC had a budget of $9 million and supported a broad mosaic of children's services. It has been able to initiate new and needed services, to support effective existing programs, and to integrate existing programs when appropriate.2 Adolescent OB/GYN services In St. Paul, Minnesota, the Chief of Obstetrics at the county hospital stated that three things made him angry. The first was that a 15-year-old pregnant patient would come to his hospital in labor without prenatal care. The second was that the same person would come back a year later with her second pregnancy and again, no prenatal care. The third was that there was an adolescent OB-GYN clinic in the county hospital—but no one came. He did something about the problem: he placed family planning services in an adjacent inner-city high school. This was not accomplished easily. It took 18 months of community meetings and generated significant controversy among parents and faculty. However, the student body leadership came forward at a critical juncture and declared its support. This tipped the scales in favor of clinical services and the school board voted in 1973 for a...