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 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.Table of ContentsFront MatterExecutive Summary1 Background and Overview2 The Core Safety Net and the Safety Net System3 Forces Affecting Safety Net Providers in a Changing Health Care Environment4 How Safety Net Providers Are Adapting to the New Environment5 The Impact of Change on Vulnerable Populations6 Safety Net Populations with Special Health and Access Needs7 Findings and RecommendationsAppendix A Committee BiographiesAppendix B Workshop AgendaAppendix C Workshop ParticipantsAppendix D California Regional Meeting AgendaAppendix E California Regional Meeting ParticipantsAppendix F New York Regional Meeting AgendaAppendix G New York Regional Meeting ParticipantsAppendix H Rural Conference Call ParticipantsAppendix I AcronymsIndex