By Kay Johnson, MPH, EdM
The Centers for Disease Control and Prevention (CDC) has made recommendations for improving preconception health and health care aimed at achieving four goals (Johnson et al., 2006). These recommendations recognized the importance of policy and finance changes. In 2007, a Policy and Finance Workgroup — representing an array of organizations including professional associations, academic institutions, and government agencies — was launched to support implementation of these recommendations. It is co-chaired by Sara Rosenbaum, Kay Johnson and Alison Johnson.
Improving health coverage for women is one needed change. The Policy and Finance Workgroup developed consensus in support of a comprehensive, annual well-woman’s health exam as a covered benefit in private and public health plans (from age 18). Adopting this approach in Medicaid, as well as private health plans, would be a major step toward assuring that preconception screening, education and interventions are covered. This approach has a parallel in the well-child visits (e.g., Bright Futures, EPSDT) and Medicare.
In the absence of larger health care reforms, Medicaid coverage for low-income women has been recommended as a way to improve preconception health. Medicaid’s family planning waivers could include basic preconception care including screening, education and/or interventions; however, federal rules for such waivers would have to be modified.
Additional public programs have great potential to improve preconception health and health care. State Title V programs can encourage development of a continuum of women's health services. The CDC and NIH have critical roles to play in advancing knowledge of science and best practice. Three existing federal programs that provide grants directly to community-based health service providers — the Community Health Center, Healthy Start, and Title X Family Planning programs — each provide capacity in communities with high concentrations of women at risk. Funding for these programs is currently below the level of funding needed to provide these services in all qualified communities. (Levi et al., 2007)
The Workgroup also has called for quality improvement efforts in key public programs. For example, to create: a women’s health improvement collaborative in community health centers; a quality assurance project in Medicaid; a quality improvement project for Title X clinics; measures for screening in chronic disease or STI/HIV prevention programs; and special incentives for State Title V programs.
A special supplement of the journal Women’s Health Issues to be published next month describes the policy and finance context for improving preconception health and health care. (Johnson et al., 2008) It discusses current policies, as well as how preconception care fits into the larger debates on health reform.
We cannot hope to achieve our goals while half of low-income women of childbearing age lack health coverage. Access will be limited if private health plans do not cover comprehensive well-woman visits, including preconception screening. Efforts to serve high risk women rely on adequate funding for programs such as Title V and Healthy Start. Isolated family planning, prenatal care, and perinatal programs miss opportunities to provide the infrastructure for a continuum of services for women. Changes in public policy and health care financing, particularly health coverage and benefits are essential for improving preconception health and health care.
Johnson K, et al. Recommendations for improving preconception health and health care – United States: a report of the CC/ATSDR Preconception Care Workgroup and the Select Panel on Preconception Care. Centers for Disease Control and Prevention. MMWR 2006;55(No. RR-6): 1-23.
Johnson K, Atrash H, and Johnson A. Policy and Finance for Preconception Care: Opportunities for today and the future. Women’s Health Issues. Supplement (In Press). December, 2008.
Levi J, Cimons M, and Johnson K. Healthy Women, Healthy Babies. Trust of America’s Health. June, 2008. Available from: www.healthyamericans.org