America's Health Care Safety Net: Intact but Endangered

America's Health Care Safety Net explains how competition and cost issues in today's health care marketplace are posing major challenges to continued access to care for America's 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―children with special needs, people with serious mental illness, people with HIV/AIDS, and the homeless.

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