Infant Toddler Development Training
Module 6, Lesson 1
History of Health Care Barriers
As explained earlier, advances in technology have improved various rates of morbidity and mortality. Prior to 1930, antibiotics were not available. Therefore, respiratory and other infectious diseases caused significant mortality in the entire population, especially in young children. As antibiotics were introduced, decreases in infectious deaths allowed some children to survive, but with residual problems. Technological gains in the 1960's and 1970's have resulted in intensive care measures allowing more premature infants to survive at earlier gestational ages. However, financing these advances and the subsequent costs of an increased number of surviving infants with disabilities and medical problems has underscored society's responsibility for allocating these resources and apportioning care for children, as well as other populations.
Overarching barriers to health care include poverty, ethnicity, and language differences. Lack of insurance and the high cost of health and medical care are the largest barriers. Other barriers include fragmented care when there is no coordination with a primary pediatrician or primary specialist who can oversee a complex condition that requires intensive management. Practitioners also have difficulty staying abreast of changes in the field. These barriers reduce their ability to deliver optimal care to children with complex medical conditions.
The emergence and practice of managed care networks sometimes works against a family who is seeking care for their child with a complex medical condition or chronic disease. The family and the primary physician must justify expenses for necessary care. The managed care systems work much better for healthy populations.
The American Academy of Pediatrics recommends that the physician maintain a central data base with pertinent diagnostic and consultative information in caring for children with disabilities and their families and help provide ongoing services designed to prevent secondary disabilities. It is believed that the delivery of quality care is more effective when a child with a chronic disease has a medical home with a primary physician who can act as a translator for health care systems and can advocate for their individual needs rather than having health care that is episodic in nature.
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