America's Health Care Safety Net

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 netwith 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 netpublic hospitals, community clinics, local health departments, and federal and state programs. Mounting pressures on the systemrising 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 environmentdetailing the evolution and impact of Medicaid managed care. Key issues highlighted in four populationschildren with special needs, people with serious mental illness, people with HIV/AIDS, and the homeless. Table of Contents Front Matter Executive Summary 1 Background and Overview 2 The Core Safety Net and the Safety Net System 3 Forces Affecting Safety Net Providers in a Changing Health Care Environment 4 How Safety Net Providers Are Adapting to the New Environment 5 The Impact of Change on Vulnerable Populations 6 Safety Net Populations with Special Health and Access Needs 7 Findings and Recommendations Appendix A Committee Biographies Appendix B Workshop Agenda Appendix C Workshop Participants Appendix D California Regional Meeting Agenda Appendix E California Regional Meeting Participants Appendix F New York Regional Meeting Agenda Appendix G New York Regional Meeting Participants Appendix H Rural Conference Call Participants Appendix I Acronyms Index