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October 25, 2000

Strengthening the US Health Care Safety Net

Author Affiliations

Author Affiliation: US Department of Health and Human Services, Washington, DC.

JAMA. 2000;284(16):2112-2114. doi:10.1001/jama.284.16.2112

Continued increases in the numbers of uninsured US citizens, increasing premiums for those who are insured, and the debate over prescription drug coverage all have served to thrust the issue of access to health care on the national radar screen once again. Since the goal of universal health insurance seems less and less likely to be realized in the near future, much of the discussion has focused on the so-called safety net, which is the loosely knit health system that cares for those outside the traditional health care marketplace, who are primarily poor and uninsured. The mere existence of the safety net, let alone our nation's dependence on it, is evidence that the market does not distribute health care in a socially equitable manner. This often ad hoc (and unheralded) system is expected to provide access to care in geographically underserved areas and to address other barriers to care, such as social and cultural factors. With the increasingly diverse US population, additional factors include whether the patient and clinician can communicate in the same language and whether they understand and are comfortable with each other's cultures.