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November 24, 1993

Fair Start for Children: Lessons Learned From Seven Demonstration Projects

Author Affiliations

Harborview Medical Center Seattle, Wash

JAMA. 1993;270(20):2499-2500. doi:10.1001/jama.1993.03510200105045

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I do not believe that the scores of planners currently devoting long hours to health care reform would appreciate learning that payment systems for medical care have little to do with improving health. Where children are concerned, for example, housing, parental education and employment, traffic engineering, nutrition, alcohol, drugs, and guns have more impact than the services provided in physicians' offices, hospitals, and clinics. Neither "managed competition" nor any other financing scheme will help with the ravages of low birth weight, fetal alcohol syndrome, the acquired immunodeficiency syndrome, or neglect and deprivation. Even less imposing problems like chronic asthma, iron deficiency anemia, baby bottle caries, sexually transmitted diseases, and hypertension of pregnancy are unlikely to be affected by the reforms currently being discussed.

What will help in the view of many of us who specialize in care of the poor are outreach services that improve coordination between medical facilities and