National Survey Shows Mixed Results for Oregon Women's Access to Adequate Health Care

07/30/03    Portland, Ore.

OHSU physician provided public health and medical perspective on Oregon

A recent national survey on women's access to health care shows mixed results for Oregon. Poor women, pregnant women, women who need contraceptives and couples seeking fertility procedures are among those who suffer most from state health care policies, according to the report.

"Women's Access to Care: A State-Level Analysis of Key Health Policies" by the National Women's Law Center and the Henry J. Kaiser Family Foundation found in general that access to health care services is still problematic for women in the United States. And Oregon is no exception, according to one of the authors, Michelle Berlin, M.D., associate professor of obstetrics and gynecology in the OHSU School of Medicine and a member of the OHSU Center for Women's Health. Berlin provided the public health and medical perspective for the Oregon statistics. She is also the primary author of "The National State-by-State Report Card on Women's Health."

"This study is further evidence that women's health continues to not receive the attention it needs," Berlin said. "I hope that policy makers pay attention to this. Oregon fails in the areas of state-mandated insurance coverage for reproductive health care. We should be better as a state. Not providing appropriate and adequate care for women has wide-ranging repercussions for health care costs and overall for the well-being of children and families in this state."

For example, there is no state mandate for insurance to cover contraceptives or infertility treatments, and there's no presumptive or retroactive Medicaid coverage for eligible women in their first trimester. States that have presumptive eligibility allow pregnant women who meet certain criteria to receive immediate, temporary Medicaid coverage while they're waiting for their application to be processed. This allows those women to obtain health care when they need it. Without this, many poorer women will not seek prenatal care.

State legislators are, however, working on several bills to address some of the issues brought up in the study, such as emergency contraception, contraceptive equity, access to prenatal care and breast reconstruction after a mastectomy.

"Without prenatal care the risks of poor birth outcomes are higher, including low birthweight, premature births, and undetected HIV and hepatitis B infection," Berlin said. "And for those women who only receive medical care during pregnancy, especially in these times of Medicaid cuts, women who don't receive prenatal care are at higher risk of cervical cancer, undetected diabetes and high blood pressure."

Of the five diseases that predominantly affect women or are major causes of death among women, only breast cancer and cervical cancer are part of a state-mandated insurance coverage screening program in Oregon. The other three -- colorectal cancer, chlamydia and osteoporosis -- are not covered by mandates.

The lack of mandated screenings for chlamydia is particularly disturbing to Berlin. The disease is the second most common bacterial sexually transmitted infection in the United States. Chlamydia is a silent disease -- often women have no symptoms -- but untreated it can lead to infertility, chronic pelvic pain and pelvic inflammatory disease. In 2001 the Centers for Disease Control and Prevention recommended that sexually active women under the age of 25 be screened for chlamydia every six months.

Other highlights of the study include:
  • Oregon does not mandate insurers pay for clinical trials. This is important because for many life-threatening illnesses such as cancer, clinical trials offer the only prospect of curing the disease or extending the patient's life.
  • Oregon's Medicaid program provides family planning services to low-income women.
  • Oregon has no policy for mental health parity. This means insurers do not have to provide full parity, such as co-payments or deductibles, for mental health service in the same way as for physical health coverage.
  • Oregon women do not need a referral and are allowed direct access to their obstetricians and gynecologists. This enhances women's ability to receive care.

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