Harriet S.MeyerMD, Contributing EditorDavid H.MorseMS, Journal Review EditorRobertHoganMD, adviser for new media
edited by Marion Ein Lewin and Stuart Altman (Committee on the Changing Market, Managed Care, and the Future Viability of Safety Net Providers, Institute of Medicine), 281 pp, $42.95, ISBN 0-309-06497-X, Washington, DC, National Academy Press, 2000; http://www.nap.edu/catalog/9612.html (includes full text and ordering information).
In the United States, people without health insurance and other vulnerable populations depend on a loosely organized "health care safety net" for access to care. Three factors threaten to overwhelm the safety net: the rising number of uninsured people, now almost one fifth of the US population; erosion and uncertainty of direct and indirect subsidies for safety-net providers; and intensified competition for Medicaid patients under managed care.
Concerned about the impact of these trends on the safety net, the Health Resources and Services Administration (HRSA) commissioned a policy study by the Institute of Medicine (IOM). The original charge to the study committee was to "examine the impact of Medicaid managed care and other changes in health care coverage on the future integrity and viability of safety net providers operating primarily in ambulatory and primary care settings." The committee, chaired by Stuart Altman, PhD, broadened the scope of its inquiry to include providers of inpatient as well as outpatient care.
Access to CareAmerica's Health Care Safety Net: Intact but Endangered. JAMA. 2000;284(16):2117-2118. doi:10.1001/jama.284.16.2117