The Health Care Safety Net in a Post-Reform World examines how national health care reform will impact safety net programs that serve low-income and uninsured patients. The “safety net” refers to the collection of hospitals, clinics, and doctors who treat disadvantaged people, including those without insurance, regardless of their ability to pay. Despite comprehensive national health care reform, over twenty million people will remain uninsured. And many of those who obtain insurance from reform will continue to face shortages of providers in their communities willing or able to serve them. As the demand for care grows with expanded insurance, so will the pressure on an overstretched safety net. This book, with contributions from leading health care scholars, is the first comprehensive assessment of the safety net in over a decade. Rather than view health insurance and the health care safety net as alternatives to each other, it examines their potential to be complementary aspects of a broader effort to achieve equity and quality in health care access. It also considers whether the safety net can be improved and strengthened to a level that can provide truly universal access, both through expanded insurance and the creation of a well-integrated and reasonably supported network of direct health care access for the uninsured. Seeing safety net institutions as key components of post-health care reform in the United States—as opposed to stop-gap measures or as part of the problem—is a bold idea. And as presented in this volume, it is an idea whose time has come.

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 netâ€"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 netâ€"public hospitals, community clinics, local health departments, and federal and state programs. Mounting pressures on the systemâ€"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 environmentâ€"detailing the evolution and impact of Medicaid managed care. Key issues highlighted in four populationsâ€"children with special needs, people with serious mental illness, people with HIV/AIDS, and the homeless.

A review of the conceptual underpinnings and operational elements of public works programs around the world., drawing from a rich evidence base and analyzing previously unassimilated data, to fill a gap in knowledge related to public works programs, now so popular.

An overview of the role played by federalism in anti-poverty policy and in poverty law.

The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.

Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.

The need for social safety nets has become a key component of poverty reduction strategies. Over the past three decades several developing countries have launched a variety of programs, including cash transfers, subsidies in-kind, public works, and income-generation programs. However, there is little guidance on appropriate program design, and few studies have synthesized the lessons from widely differing country experiences. This report fills that gap. It reviews the conceptual issues in the choice of programs, synthesizes cross-country experience, and analyzes how country- and region-specific constraints can explain why different approaches are successful in different countries.

Poverty remains a pervasive and complex phenomenon in Sub-Saharan Africa. Part of the agenda in recent years to tackle poverty in Africa has been the launching of social safety nets programs. All countries have now deployed safety net interventions as part of their core development programs. The number of programs has skyrocketed since the mid-2000s though many programs remain limited in size. This shift in social policy reflects the progressive evolution in the understanding of the role that social safety nets can play in the fight against poverty and vulnerability, and more generally in the human capital and growth agenda. Evidence on their impacts on equity, resilience, and opportunity is growing, and makes a foundational case for investments in safety nets as a major component of national development plans. For this potential to be realized, however, safety net programs need to be significantly scaled-up. Such scaling up will involve a series of technical considerations to identify the parameters, tools, and processes that can deliver maximum benefits to the poor and vulnerable. However, in addition to technical considerations, and at least as importantly, this report argues that a series of decisive shifts need to occur in three other critical spheres: political, institutional, and fiscal. First, the political processes that shape the extent and nature of social policy need to be recognized, by stimulating political appetite for safety nets, choosing politically smart parameters, and harnessing the political impacts of safety nets to promote their sustainability. Second, the anchoring of safety net programs in institutional arrangements †“ related to the overarching policy framework for safety nets, the functions of policy and coordination, as well as program management and implementation †“ is particularly important as programs expand and are increasingly implemented through national channels. And third, in most countries, the level and predictability of resources devoted to the sector needs to increase for safety nets to reach the desired scale, through increased efficiency, increased volumes and new sources of financing, and greater ability to effectively respond to shocks. This report highlights the implications which political, institutional, and fiscal aspects have for the choice and design of programs. Fundamentally, it argues that these considerations are critical to ensure the successful scaling-up of social safety nets in Africa, and that ignoring them could lead to technically-sound, but practically impossible, choices and designs.

This is an edited volume reviewing the major means-tested social programs in the United States. Each author addresses a major program or area, reviewing each area’s successes and recommending how to address shortcomings through policy change. In general, our means-tested programs do many things well, but some adjustments to each could make the system much more effective. This book provides policymakers with a broad overview of the issues at hand in each program and how to address them.

"Today Singapore ranks sixth in the world in healthcare outcomes well ahead of many developed countries, including the United States. The results are all the more significant as Singapore spends less on healthcare than any other high-income country, both as measured by fraction of the Gross Domestic Product spent on health and by costs per person. Singapore achieves these results at less than one-fourth the cost of healthcare in the United States and about half that of Western European countries. Government leaders, presidents and prime ministers, finance ministers and ministers of health, policymakers in congress and parliament, public health officials responsible for healthcare systems planning, finance and operations, as well as those working on healthcare issues in universities and think-tanks should know how this system works to achieve affordable excellence."--Publisher's website.