Women and national health insurance: issues and solutions

An effective national health insurance program should provide adequate, continuous, and comprehensive coverage for all. In framing current proposals, it seems that policy makers have not adequately considered differences in medical care utilization and needs between men and women. The inequities which result occur primarily because women now have two central sources of medical care--an obstetrician/gynecologist and a general practitioner or internist-while men have only one. The article delineates four issues of particular importance to women: 1) eligibility provisions which insure women through their husbands' policies; 2) benefit structures which exclude aspects of reproductive health services and/or fail to explicitly recognize women's two central sources of care; 3) provider certification provisions which exclude free-standing clinics and/or nonphysician personnel, and 4) incentives for reform of health delivery which force women to choose between their two current sources of care. The analysis concludes that current proposals contain provisions which, if enacted, would lead to inequities for women. Alternative solutions which might be explored are discussed and principles which could serve as guidelines for developing specific proposals are presented.