Women's Healthcare

The federal government plays a major role in the health of women throughout the nation. Through national programs and assistance to the states, the federal government can establish laws addressing private and public health care policies, fund health and ancillary services to individuals, and fund and conduct public education and outreach campaigns. Unfortunately, over the last several years, federal policy has moved in the wrong direction in ways that have a major adverse impact on women's health.

Adoption of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 has resulted in significant changes to Medicare's core structure, and created grave consequences for the lowest income beneficiaries, primarily women. The new program's systemic problems are numerous, including an overly complex structure that is confusing for beneficiaries to use and limits coverage for many even if they can navigate the system. Perhaps most egregious is the Part D prescription drug benefit plan which went into effect on January 1, 2006. It eliminated federal funding for secondary prescription drug coverage through Medicaid for the poorest Medicare beneficiaries, leaving them with few viable alternatives for securing their costly prescriptions. The law also created a gap known as the "donut hole" that caps the benefit for Part D beneficiaries who meet an initial coverage limit, forcing them to pay the full costs for any drugs they need beyond that limit unless they reach the "catastrophic coverage" ceiling

The Administration supports restructuring Medicaid from an entitlement program, in which everyone who is eligible may be enrolled, to a block grant, which provides only a finite allotment of funds to each state. Under a block grant approach, because the funds would be limited, eligible persons could nonetheless be denied coverage and fewer services would be covered for those who are enrolled. The cuts in state programs resulting from block grants would disproportionately hurt women, since women are the majority of adult beneficiaries

Any federal efforts to improve women's health, including Medicare and Medicaid, require resources. But a series of large tax cuts enacted in the last few years leave few federal dollars to target health needs. More tax cuts are being proposed, which could mean even fewer resources would be available to meet the needs of women's health, just when the country will be faced with the retirement of the baby boom generation and a substantial increase in costs associated with this expansion of the aging population.

Sliding scale insulin (SSI) is frequently used for inpatient management of hyperglycemia and is associated with a large number of medication errors and adverse events including hypoglycemia and hyperglycemia. One year after implementation the physician order form was used for 91% of orders and, overall, 86% of SSI orders followed the guidelines. The number of prescribing errors found on chart review was reduced from 10.3 per 100 SSI patient-days at baseline to 1.2 at 1 year (p = 0.03). The number of hyperglycemia episodes 1 year after implementation decreased from 55.9 to 16.3 per 100 SSI patient-days.

Throughout the United States, the growth of managed care is forcing pediatric providers (physicians and hospitals) to reconstruct and integrate the health care delivery system with a focus away from the academic center and toward the community. Managed care also is forcing new financing approaches geared toward the assumption of economic risk for patient

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