July 10, 1987

Can Access Be Improved While Controlling Costs?

Author Affiliations

Rye, NY

Rye, NY


edited by Gretchen V. Fleming and Ronald M. Andersen (Municipal Health Services Program), 343+ pp, $27.95, Chicago, Pluribus Press Inc, 1986.

JAMA. 1987;258(2):270-271. doi:10.1001/jama.1987.03400020112049

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On the surface, this book is a straightforward, in-depth evaluation of a major health care provision project carried out in five cities between 1978 and 1984. But behind its cold tables and statistics, a reader gets a sense of the human values invested in the project, of the hopes— and disappointments—that accompanied it.

The dream was a noble one, posing the question: Can a better way be found for providing health services to the inner-city poor? The stimulus for the Municipal Health Services Program (MHSP) project came, like many other good ideas these days, from the Robert Wood Johnson Foundation, which contributed $3 million to each of five sites for the planning and start-up costs of establishing inner-city primary care centers. A second funding source was the Health Care Financing Administration, which arranged for a waiver program that would encourage people to use the primary care centers (by forgiving the