{"id":105,"title":"Assisted reproduction in the public sector: why secondary-level hospitals matter for equity and continuity of care","title_zh":"公共部门的辅助生殖：二级医院为何对公平性与诊疗连续性至关重要","url":"https://pubmed.ncbi.nlm.nih.gov/42973803","doi":"10.3389/frph.2026.1974930","pmid":"42973803","journal":"Front Reprod Health","kind":"paper","lang":"en","published_at":"2026-10-19T00:00:00+00:00","fetched_at":"2026-11-08T03:43:53+00:00","authors":["Endara-Mina J","Bermúdez-Gavilanes J","Salazar FR","Manzano-Gallegos LA","Figueroa-Andrade JM","Ortega-Parraga DN","González-Naranjo DE","Maldonado-Montalvan F","Reytor-González C","Simancas-Racines D"],"primary_topic":"art-clinical","topics":[{"slug":"art-clinical","score":5.0,"hits":["assisted reproduction","assisted reproductive","infertility"]}],"topic_score":5.0,"preference_score":0.0,"preference_labels":[],"llm_score":70.0,"final_score":70.0,"score_dims":{"novelty":62,"rigor":60,"impact":66,"relevance":72,"translation":65},"recommend_reason":"选题切中ART公平可及这一被忽视的卫生系统层面议题，提供可操作的八项政策优先与实施框架，适合从事公共卫生、生殖中心建设与转诊体系规划者参考；但属叙述性政策综述，缺乏原始数据与效果验证，对实验室与胚胎学读者直接价值有限。","keywords":["辅助生殖技术","卫生公平与可及性","二级医院","转诊路径","连续性照护","卫生政策与筹资"],"selected":1,"story_id":377,"llm_provider":"deepseek","llm_model":"deepseek-flash","llm_effort":"low","source_key":"pubmed-art","source_name":"PubMed · 辅助生殖临床","source_tier":1,"mention_count":1,"has_interpretation":false,"journal_key":null,"journal_tier":"standard","journal_if":null,"is_mock":false,"summary_zh":"本文为政策与实践综述，检索 PubMed/MEDLINE、Scopus、Web of Science 与 LILACS 四个数据库（不限发表时间，含英、西、葡文献），主题化整合辅助生殖技术（ART）在可及性、服务组织、转诊路径、连续性照护、人力、信息系统、治理与筹资方面的证据，并经专家参与的政策分析解读。结果归纳出地理、经济、组织与卫生系统四类障碍，提出由专科中心承担高复杂度操作、由二级医院承担不孕评估、转诊协调、随访与妊娠监测的整合模式，并总结八项政策优先方向，构建含责任主体、最低资源、实施阶段、障碍与监测指标的实施框架。结论认为整合二级医院可改善连续性照护与地理可及性，但获益仍需前瞻性评估。","summary":"BACKGROUND: Infertility is a major public health challenge, yet access to assisted reproductive technology (ART) remains unequal, particularly where public provision is limited. This Policy and Practice Review examines the role of secondary-level hospitals in integrating ART into public health systems. METHODS: A structured literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and LILACS, without publication-date restrictions, including literature in English, Spanish, and Portuguese. Evidence on access, service organization, referral pathways, continuity of care, workforce, health information systems, governance, and financing was synthesized thematically and interpreted through expert-informed policy analysis. RESULTS: The review identified geographic, financial, organizational, and health-system barriers to equitable ART access. Integrated models may allow specialized centers to retain high-complexity procedures while secondary-level hospitals support infertility assessment, referral coordination, follow-up, and pregnancy surveillance. Eight policy priorities were identified: integration of secondary-level hospitals; standardized referral pathways; workforce development; national ART registries; equity-oriented evaluation; patient and community participation; integrated governance and quality assurance; and sustainable financing. An implementation framework specifying responsible actors, minimum resources, implementation phases, barriers, and monitoring indicators was developed. CONCLUSION: Integrating secondary-level hospitals into coordinated ART networks may strengthen continuity of care, geographic accessibility, and use of specialized resources. These potential benefits require prospective evaluation during implementation.","interpretation_basis":null,"fulltext_status":null,"interpretation":null,"fulltext":{"available":false,"status":null,"reason":"尚未抓取全文（未入选、分数未达阈值，或还没跑 fulltext 步骤）","pmcid":null,"license":null,"chars":0,"source":null,"fetched_at":null}}