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Access to Health Care in America (1993)
Institute of Medicine (IOM)

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. "5. Recommendations." Access to Health Care in America. Washington, DC: The National Academies Press, 1993.

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Access to Health Care in America
  1. Wherever possible, data on Hispanics should be collected and analyzed according to individual ethnic subgroups. (National Center for Health Statistics, Public Health Service, States)

Indicator: Low Birthweight
  1. Research and data analysis should focus on the large and growing disparity between the incidence of low birthweight and very-low-birthweight infants among blacks and the incidence among other groups. (Researchers)

  2. Better data are needed on barriers to access, especially concerning maternal income and insurance status. In the interim it may be possible to use data from the National Maternal and Infant Health Survey or from states that have linked data from Medicaid and birth records. Efforts should also continue to link zip code information on birth records with census income data to allow small-area analyses. (National Center for Health Statistics, Public Health Service, Researchers)

  3. The Public Health Service should investigate ways to overcome delays between the collection of data and analysis and dissemination of vital statistics and survey information. (Public Health Service)

  4. Research should continue into the differences in birth outcomes between first- and subsequent-generation mothers to gain a better understanding of how culture affects health care. (Researchers)

Indicator: Congenital Syphilis
  1. To identify the root causes of congenital syphilis, additional research is necessary to investigate how access problems contribute to the large disparities between the incidence of primary and secondary syphilis for whites and that for blacks. (Researchers)

  2. Further research is needed into the relationships among drug use, prenatal care, and congenital syphilis. The results of this research may allow interventions to be tailored to those afflicted by these complex social and health problems. (Researchers)

Objective 2: Reducing the Incidence of Vaccine-Preventable Childhood Diseases

Indicator: Preschool Immunization
  1. The federal government should sponsor a school-based immunization reporting system under which schools would report to state health departments when entering students had completed their immunization schedules. The data would be aggregated at the federal level to provide a retrospective

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