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  • Title: Abortion services under national health insurance: the examples of England and France.
    Author: Henshaw SK.
    Journal: Fam Plann Perspect; 1994; 26(2):87-9. PubMed ID: 8033984.
    Abstract:
    The US can anticipate possible problems and benefits of different financing mechanisms as it moves to providing national health insurance coverage. England, Wales, and France have a national health service with a policy mandating abortion services. Examination of these systems shows that bureaucratic health care structures do not assure that all women have access to abortion services, however. Ideological, budgetary, and bureaucratic resistance operates at many public hospitals and public sector services. Abortion services always are a target for spending cuts when there is limited health care funding. In the US, the strong anti-abortion faction is likely to pressure health maintenance organizations and other managed care systems to limit access to abortion services. In the UK and France, independent, private health facilities fill the gaps in the public system and thus provide women universal access to abortion services. These facilities are at least as necessary in the US as they are in the UK and France. UK's National Health Service process of abortion referral delays abortions. In the UK and France, women tend to view public facilities as lacking confidentiality, so they automatically go to private providers. Other problems with obtaining a referral by a primary care provider include an extra health care visit, that the provider may not make or may delay the referral, and the woman's desire not to discuss the pregnancy with the regular provider. Bureaucratic and legal barriers in France force many women to seek and physicians to perform illegal abortions. Barriers in France are a one-week waiting period, required counseling by a social worker, and a required overnight stay in the hospital. These barriers must be avoided in the US to prevent illegal abortions.
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