Health care system reform and public health. Protecting the safety net
C. M. Helms and P. C. Damiano
University of Iowa, Iowa City.
The most difficult to reach underserved populations are not likely to
disappear even with universal insurance coverage. Universal coverage does
offer all educated and motivated individuals, including those lacking
financial resources, the opportunity to seek improved health through
prevention services and treatment for illness. But, it would not guarantee
that uneducated and unmotivated people, substance abusers, the chronically
mentally ill, people with geographic or cultural barriers to access, or
other traditionally underserved populations will use or be able to use a
new system more wisely. These last groups, who, for various reasons, may
underuse prevention services or delay contact until disease is transmitted
or illness is advanced, will continue to add costs to a reformed health
care system. Care must therefore be exercised in health care system reform
to provide incentives for private-sector outreach to these problem
populations. Even with incentives, however, history suggests that the
private sector will either avoid or have difficulty incorporating the large
groups of disadvantaged patients who in the past have relied on public
health services and public hospitals for their health care. The public
health sector will need to maintain the capacity to provide for the health
care of many disadvantaged groups with historically poor access. It becomes
critical in the budgetary trade-offs inherent in health care system reform
that the infrastructure of the public health system not be
damaged.(ABSTRACT TRUNCATED AT 250 WORDS)
