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Managed Care - Americas Health Care Safety Net: Intact But Endangered

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Americas Health Care Safety Net explains how competition and cost issues in todays health care marketplace are posing major challenges to continued access to care for Americas poor and uninsured. At a time when policymakers and providers are urgently seeking guidance, the committee recommends concrete strategies for maintaining the viability of the safety net - with innovative approaches to building public attention, developing better tools for tracking the problem, and designing effective interventions. This book examines the health care safety net from the perspectives of key providers and the populations they serve, including: components of the safety net - public hospitals, community clinics, local health departments, and federal and state programs. Mounting pressures on the system - rising numbers of uninsured patients, decline in Medicaid eligibility due to welfare reform, increasing health care access barriers for minority and immigrant populations, and more. Specific consequences for providers and their patients from the competitive, managed care environment - detailing the evolution and impact of Medicaid managed care. Key issues highlighted in four populations are - children with special needs, people with serious mental illness, people with HIV/AIDS, and the homeless.

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title Americas Health Care Safety Net Intact but Endangered author - photo 1

title:America's Health Care Safety Net : Intact but Endangered
author:Lewin, Marion Ein.
publisher:National Academies Press
isbn10 | asin:030906497X
print isbn13:9780309064972
ebook isbn13:9780585317441
language:English
subjectMedical assistance--United States, Medical care--Needs assessment--United States, Medically uninsured--United States, Poor--Medical care--United States, Medical Assistance--United States, Delivery of Health Care--United States, Medically Uninsured--United
publication date:2000
lcc:RA395.A3A5965 2000eb
ddc:362.1/0973
subject:Medical assistance--United States, Medical care--Needs assessment--United States, Medically uninsured--United States, Poor--Medical care--United States, Medical Assistance--United States, Delivery of Health Care--United States, Medically Uninsured--United
Page i
America's Health Care Safety Net
Intact but Endangered
Marion Ein Lewin and Stuart Altman, Editors
Committee on the Changing Market, Managed Care, and the
Future Viability of Safety Net Providers
INSTITUTE OF MEDICINE
Page ii NATIONAL ACADEMY PRESS 2101 Constitution Avenue NW Washington D - photo 2
Page ii
NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D 20418
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
Support for this project was provided by the Health Resources and Services Administration (Contract No. 240-97-0030). The views presented in this report are those of the Institute of Medicine Committee on the Changing Market, Managed Care, and the Future Viability of Safety Net Providers and are not necessarily those of the funding agency.
Library of Congress Cataloging-in-Publication Data
America's health care safety net: intact but endangered / Committee on the
Changing Market, Managed Care, and the Future Viability of Safety Net
Providers; Marion Ein Lewin and Stuart Altman, editors.
p.; cm
Includes bibliograpical references and index.
ISBN 0-309-06497-X (hardcover)
1. Medical assistanceUnited States. 2. Medical careNeeds
assessmentUnited States. 3. Medically uninsuredUnited States. 4. Poor
Medical careUnited States. I. Lewin, Marion Ein. II. Altman, Stuart H.
III. Institute of Medicine (U.S.). Committee on the Changing Market,
Managed Care, and the Future Viability of Safety Net Providers.
[DNLM: 1. Medical AssistanceUnited States. 2. Delivery of Health
CareUnited States. 3. Medically UninsuredUnited States.
W 250 AA1 A512 2000]
RA 395.A3 A5965 2000
362.1'0973dc21 00-033231
Additional copies of this report are available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, DC 20055. Call (800) 6246242 or (202) 3343313 (in the Washington metropolitan area), or visit the NAP's home page at www.nap.edu . The full text of this report is available at www.nap.edu .
For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu.
Copyright 2000 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
Page iii
Knowing is not enough we must apply Willing is not enough we must do - photo 3
"Knowing is not enough; we must apply.
Willing is not enough; we must do."
Goethe
INSTITUTE OF MEDICINE Shaping the Future for Health Page iv - photo 4
INSTITUTE OF MEDICINE
Shaping the Future for Health
Page iv
THE NATIONAL ACADEMIES
National Academy of Sciences
National Academy of Engineering
Institute of Medicine
National Research Council
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.
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