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OCR for page 263
A
In(QX
Academic health centers, 48, 66, 83, 111,
148-149, 195, 209
Academic medical centers, 4, 23, 24, 56,
65-66,72,84,114,116-117,135,
145, 146, 148-149, 161
Accessibility, health care, 1, 3, 4, 8, 10,
21, 27, 74, 175
beneficiary choice, 7, 25, 30, 83-84,
166-170, 206-207; see also
"mainstreaming" infra
commercial vs Medicaid managed
care, 161
community funding, 13, 14
community health centers, 59-60
cost sharing/out-of-plan decisions,
32-33
emergency care, 36
local health departments, 63
mainstreaming, 26, 30, 38-39, 135,
170-173, 176, 195
Medicaid managed care, 161, 162-164,
170-173
nonfinancial barriers, 166
cultural factors, 21, 24, 41, 60, 159
language barriers, 21, 24, 41, 48,
52, 53, 59, 73
telephone access, 14, 161, 217
transportation to care, 7, 21, 48, 56,
59,137,161,163,166,185,197
outreach, 7, 13, 34, 48, 51, 57, 61, 74,
95, 97, 109, 166, 168, 208
special-needs patients, 181, 195,
197, 198, 199, 218
primary care, 7, 164
primary care case management, 31-
32, 139, 148, 149, 150, 162-163
private practitioners, 162
special-needs patients, 13, 51, 195,
197, 198, 199, 218
outreach, 181, 195, 197, 198, 199,
218
see also Advocacy; Core safety net
providers; Insurance;
Uninsured / underinsured
persons
Accountability, 11, 136, 214
community services funding, 13
Medicaid, 29, 107, 133
special-needs patients, 199, 201
Administrative requirements
community health centers, 63,
102(n.25)
cost-based reimbursement, 102(n.25)
263
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264
federally qualified health centers, 142
hospitals, 145-146, 208
protocols, 136, 211
rural areas, 150
state Medicaid programs, 18, 108,
132, 135, 145-146, 147, 150, 161,
172,185,208
waivers, 71
Adverse risk selection, 12, 148, 194, 215
Advocacy, 26, 63, 136, 168, 198, 199-201,
231
self-advocacy skills, 161
special-needs patients, 199-200
African Americans, 54, 73
AIDS/HIV patients, 193
uninsured, 40
Agency for Health Care Policy and
Research, 74
AIDS/HIV, 20, 51, 53, 57, 72, 141, 181,
192-195, 200
African Americans, 193
homeless persons, 196
local health departments, 64, 125,
151
Medicare, 192, 193
Aid to Families with Dependent
Children, 26, 92, 146, 147, 184
Alabama, 112
Alpha Center, 133
Ambulatory care, 25, 58, 60, 194-195
charity care, 65
core safety net providers, 21, 48, 55
disproportionate share hospital
funds, 100
Native Americans (FQHCs), 60
public hospitals, 25, 55, 58
state policy, 153
see also Clinics; Community health
centers; Federally qualified
health centers
Ambulatory Care Group, 194-195
American Hospital Association, 65-66
American Indians, see Native Americans
American Indian Self-Determination
Act, 60
Americans with Disabilities Act, 181,
182
Arizona, 30
INDEX
B
Bad debt, see Uncompensated care
Balanced Budget Act (BBA), 5, 12, 24, 34,
35-37, 101-102, 103, 154, 206,
211, 215
Medicare, 35, 142
special-needs patients, 35, 182
State Children's Health Insurance
Program (SCHIP), 11-12, 34, 40,
69, 92, 97-98, 215
Balanced Budget Refinements Act, 5-6,
35, 101
Black persons, see African Americans
Blue Cross Blue Shield, 133(n.1)
Boston, Massachusetts, 84, 174
Bureau of the Census, 86
Current Population Survey, 52, 85, 89
Bureau of Primary Health Care, 41, 73,
143-144
C
California, 23
hospital market consolidation, 112
Medicaid managed care, 30, 153, 154,
169
special-needs children, 187
Capitation rates, 16, 139, 161
Medicaid, 9, 30, 36, 38, 93, 109-111,
152, 155-156, 161, 173, 176, 209
special-needs patients, 187-188,
192, 194-195
CareOregon, 141, 172
Census Bureau, see Bureau of the Census
Center for Health Services Research and
Policy, 170
Center for Studying Health System
Change, 33-34
Centers for Disease Control and
Prevention, 14, 213, 217
Charity care, 9, 24, 55, 174, 175
homeless persons, 197
hospitals, 55, 65, 113
Medicaid and, 6, 8, 40-41
physicians and, 6, 24, 67-68
see also Core safety net providers;
Disproportionate share
hospitals; Uncompensated care
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INDEX
Children, 32
African Americans, infant mortality,
73
AIDS/HIV patients, 194
Aid to Families with Dependent
Children/Temporary
Assistance to Needy Families,
26, 92, 146, 147, 184
community health centers, 73-74
Early and Periodic Screening,
Diagnosis, and Treatment
program, 56, 64-65, 126, 186
homeless, 196
immunizations, 56, 57, 61, 64, 125,
164, 186
local health department services, 64,
124
Medicaid enrollment trends, 94, 184
Title V (Social Security Act), 12, 56,
185, 186, 188
uninsured, 133; see also State
Children's Health Insurance
Program
see also Special-needs children
Chronically ill persons, 21(n.3), 181
core safety net, 51
homeless, 196
Medicaid managed care populations,
162, 180
public teaching hospitals, 161
state disability payments, 111
vulnerable populations, 159
see also AIDS/HIV; Disabled persons;
Mental health and illness;
Special health care needs;
Special needs children
Cities, see Urban areas
Clinics, 4, 13, 17, 22, 23, 28, 41, 47
homeless persons, 197-198
Medicaid patients, 48
uninsured patients, 48
see also Community health centers;
Federally qualified health
centers
Colorado, 145-146, 173
The Commonwealth Fund, 52, 68, 113,
140
Community Access Program, 14, 153,
217
265
Community health centers (CHCs), vii-
viii 4, 5-6, 47, 59-63, 72-74, 119-
123
disproportionate share hospital
funds, 100
funding, proposed, 22, 23, 25
homeless persons, 197
managed care organizations (MCOs)
and, 41, 137-139, 144
Medicaid, general, 61, 62, 72-73, 119-
122, 138-139
Medicaid managed care, 41, 133, 135,
136, 137-144
mental health, 189
organizational factors, 83, 84, 212
rural areas, 28, 54, 62-63
self-paying patients, 61
study at hand, methodology, 23, 25,
27
welfare reform, 93
see also Federally qualified health
centers
Community Health Plan of Washington,
138
Competition, 6, 8, 14, 16, 25, 35, 106
disproportionate share hospitals, 100
economies of scale, 136, 145, 211
grants, 12
hospitals and clinics, 16, 71, 112-113,
209
managed care, general, 40, 41, 42,
106-107, 136, 140
market share, 6, 16, 22, 106, 108, 112-
113, 132-133, 136
Medicaid market, 25, 31, 38, 39, 126,
132,170
price, 3, 19, 82, 83-84, 106, 153, 206
see also Market forces
Congress (U.S.)
committee mission, 11
core safety net providers, 54
cost-based reimbursement, 71
low-income uninsured, bills, 34
managed care, 30
see also Legislation
Congressional Budget Office (CBO), 97,
101
Consumer Assessment of Health Plans,
165
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266
Contact Health Services program, 70
Core safety net providers, 4-8, 9, 10, 21-
24, 47-75, 205, 206
defined, 3-4, 6, 21-22, 47, 54
disabled persons, 183-184
federal initiative, 215-217
grants, 6-7, 12-13, 14, 39, 49, 54-55,
120, 121
hospitals, 22, 23, 41, 105, 114-115, 118,
147-149; see also
Disproportionate share
hospitals
local government role, general, 23,
103-105, 113, 148
Medicaid, general, 49, 113-114
Medicaid managed care, 21, 25, 41-43,
111-112, 126, 132, 134, 136-152,
206-208, 209-210
Medicare, 42, 55, 56, 57, 58, 60, 61, 62
organizational factors, 24-25, 38, 54-
55, 56-57, 62, 74, 75
subsidies, 4, 10, 17, 23, 25, 40-42, 49,
209-210
uninsured persons, 3-4, 5, 21-24, 27-
28, 47-48, 50, 55, 56, 58, 59, 209
see also Charity care; Community
health centers;
Disproportionate share
providers, general; Federally
qualified health centers;
Uncompensated care
Cost and cost-effectiveness, 16
AIDS/HIV treatment, 192-194, 199
community health centers, 73
core safety net providers, 48-49
employer-based insurance, 50
hospitals, financial performance, 114-
119, 144-145
local health departments, 125-126
Medicaid managed care, 29, 30, 31,
32, 35-37, 43, 107, 135, 139, 140-
141, 142, 143, 153
mentally ill persons, treatment, 188
outreach efforts, 166
pharmaceuticals, 91
special-needs patients, 188, 192-194,
199, 200
uncompensated care, hospitals, 58-59,
105
INDEX
underinsured persons, 91
see also Efficiency, economic; terms
beginning "Risk... "
Cost-based reimbursement, 5, 20(n.2),
24, 31, 35, 39, 40, 60
federally qualified health centers, 24,
35, 40, 71-72, 101-103, 120-121,
126, 206, 210
Rural Health Clinic program, 63
County-level efforts, 23, 56, 57, 64-65, 66,
73, 74, 103, 104-105
hospitals, 105
special-needs children, 187-188
Cultural factors, 21, 24, 41, 159
federally qualified health centers, tax-
exempt, 60
language barriers, 21, 24, 41, 48, 52,
53, 59, 73
Current Population Survey, 52, 85, 89
D
Dallas, Texas, 62
Demographic factors, 175, 198
access to care, 175
AIDS/HIV patients, 193
educational attainment, 21
risk adjustment, 173
see also Children; Immigrants;
Migrant health care; Minority
groups; Women
Dental care, 55, 57, 61, 70, 72, 73, 125,
152, 197, 198
Denver Health, 55, 56, 59(n.4), 145-146,
151, 212
Department of Agriculture, 214
Department of Commerce, see Bureau of
the Census
Department of Defense, 214
Department of Health and Human
Services
Agency for Health Care Policy and
Research, 74
Bureau of Primary Health Care, 41,
73, 143-144
Centers for Disease Control and
Prevention, 14, 213, 217
grant funding, 13-14, 216-217
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INDEX
homelessness, 197
Indian Health Service, 69-70, 85, 213-
214
local health departments, guidelines,
63
Medicaid managed care, state
waivers, 31, 37, 71, 93-94
study at hand, directives for, 17
see also Health Care Financing
Administration; Health
Resources and Services
Administration; Maternal and
Child Health Bureau
Department of Health and Human
Services Appropriations Act,
153
Department of Housing and Urban
Development, 196, 214
Department of State, 214
immigrants, 40
Department of Veterans Affairs, 214
see also Veterans Administration
Detroit, Michigan, 23
Disabled persons, 21, 29, 32, 51, 161, 181,
198
Americans with Disabilities Act, 181,
182
defined, 181-182
see also Chronically ill persons;
Mental health and illness;
Special health care needs;
Special needs children
Disproportionate share hospitals
(DSHs), 5, 12, 17, 23, 56, 65-66,
98-101, 104, 106
Balanced Budget Act, 36-37
case study, 141
drugs, discounts, 91
funding, 10, 12-14, 23, 40-41, 49, 59,
98-100
historical perspectives, 40, 98-100
Medicaid, 10, 18, 29, 36-37, 40, 49, 98-
101 (passim), 110, 126, 141, 174,
184, 213
Medicare, 10, 40, 56, 98(n.18), 100, 213
public, 17, 40
state government role, 40, 98-101, 110
taxes, 99
267
Disproportionate share providers,
general, 17, 21-22
Drugs, see Pharmaceuticals and
pharmacists; Substance abuse
E
Early and Periodic Screening, Diagnosis,
and Treatment program, 56,
64-65, 126, 186
Economies of scale, 136, 145, 211
Education, public, 63, 168, 169
see also Outreach
Education and training, professional
academic health centers, 48, 66, 83,
111, 148-149, 195, 209
academic medical centers, 4, 23, 24,
56,65-66,72,84,114,116-117,
135, 145, 146, 148-149, 161
graduate medical education, 28, 56,
66, 72, 106, 148, 251
minority students, 68
public teaching hospitals, 48, 148, 161
school-based health centers
Efficiency, economic, 16, 28, 140
buildings, 13
hospital ownership consolidation, 113
hospitals, general, 144-145
local health departments, 125
provider-level, 41-42, 70-71
see also Cost and cost-effectiveness;
terms beginning "Risk...'
Elderly persons, 32, 94, 184
see also Medicare
Emergency care, 161
access to, 36
children, 73-74
homeless persons, 196
local health departments, 64
uninsured persons, 1-2, 65
Emergency Food and Shelter Program,
197
Employer-sponsored insurance, 86, 173
costs, 50, 86
eligibility, 86
Health Insurance Portability and
Accountability Act, 34, 95,
97(n.13)
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268
Health Plan Employer Data and
Information Set, 164-165
managed care, 16, 67-68
private practitioners, 67-68
tax incentives, 34-35
Employment, other, see Self-employed
persons; Unemployed persons;
Workers
Ethnicity, see Immigrants; Minority
groups
F
Families USA Foundation, 39
Family planning, 4, 61, 62, 64, 65, 125,
152, 154
Federal government, 9, 10, 69-70, 152-
153, 212
Revolution of responsibility to state/
local governments, general, 16,
29, 74, 104, 164(n.2), 185, 210
monitoring of delivery systems, 10-
12, 36, 210-211, 213-215
poverty level, 29, 33, 58, 67, 86 (n.3),
87-88, 97
tax credits, 34-35, 95
technical assistance, 11, 14, 140, 143,
171,214,217
uninsured persons, 34-35
see also Funding; Legislation;
Medicaid; Medicaid managed
care; Medicare; specific
departments and agencies
Federally qualified health centers
(FQHCs), 4, 5, 12, 48, 52-53, 56,
57, 60-61
commercially insured patients, 54
cost-based reimbursement, 24, 35, 40,
71-72, 101-103, 120-121, 126,
206, 210
drugs, discounts, 91
financial condition, 119-123, 133
grants, 20(n.2), 29, 120, 121, 122
"look-alikes," 62, 102-103
managed care organizations and, 35,
36, 137-138, 142-143
Medicaid patients, 5, 31, 35, 36, 48,
54, 120-123, 133, 137-144, 153
INDEX
Medicare patients, 31, 60, 62, 102-103,
120, 142
minority patients, 52-53
number of patients served, 60
payment structure, 49
poor patients, 52; see also "Medicaid
patients" supra
state support, 101-103, 153
study at hand, methodology, 19-20,
27
technical assistance, 11, 14, 140, 143,
171,214,217
uninsured patients, 5, 52, 61, 119-122
(passim)
Fee-for-service coverage, 16
AIDS/HIV patients, 195
core safety net providers, 42
Medicaid, 29, 31, 32, 35, 42, 110, 163
Florida, 112, 113, 153, 174
Food and Drug Administration, 193
Funding, vii, 6, 17, 126, 215-217
charity care, 8
disproportionate share hospitals, 10,
12-14, 23, 40-41, 49, 59, 98-100
diversification, 136, 155, 211
local health departments, 65
local safety nets, support for, 10, 65
Medicaid waivers, 93-94, 103
Omnibus Budget Reconciliation Act,
30, 31, 98
patchwork, 9, 17, 54-55, 56-57, 62, 75,
210, 211-212
rural areas, 28, 55, 57
school-based health centers, 69
study at hand, methodology, 19
study at hand, sponsorship, 2, 19
see also Balanced Budget Act;
Balanced Budget Refinements
Act; Grants; Subsidies
The Future of Public Health, 63
FY 2000 Appropriations Act, 14
G
General Accounting Office (GAO), 39,
101, 169
Geographic factors, 1, 24, 84
Medicaid managed care, 36
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INDEX
medically underserved areas
(MUAs), 5, 21, 53-54, 60
uninsured persons, 89-91
see also Local areas, general; Regional
factors; Rural areas; State-level
trends; Urban areas
George Washington University, 170, 190
Georgia, 112
Grants, 49
core safety net providers, general, 6-
7, 12-13, 14, 39, 49, 54-55, 120,
121
federal, 12-13, 14, 49, 50, 54-55, 56, 64,
120, 121, 122, 140, 151-152, 189,
196-197, 215-216
section 330 grants, 20(n.2), 56, 57,
60
federally qualified health centers,
20(n.2), 29, 120, 121, 122
homeless persons, 196-197
local health departments, 64, 151
local/state governments, 5, 6, 13, 49,
54-55, 56, 57, 122, 140, 151, 189,
196
mental health, 189
State Children's Health Insurance
Program (SCHIP), 11-12, 34, 40,
69, 92, 97-98, 215
H
Hawaii, 133, 147
Head Start program, 213
Health and Hospital Corporation, 147-
148
Health Care Financing Administration
(HCFA), 14, 31, 98, 213
disabled persons, 182
Medicaid capitation rates, 110
Medicaid managed care costs, 30
Quality Assurance Reform Initiative,
164
Health insurance, see Insurance
Health Insurance Portability and
Accountability Act, 34, 95,
97(n.13)
Health maintenance organizations
enrollment/profit trends, 16, 107,
110, 113, 171
269
local health departments and, 65, 124
nonprofit, conversion to for-profit,
113
Medicaid participation, 32, 38, 65,
109, 110, 111, 138-139, 146, 148,
149-150, 171
quality of care, 163-164
special-needs children, 187
Health Plan Employer Data and
Information Set, 164-165
Health Resources and Services
Administration (HRSA), 2, 14,
56, 57, 140, 213, 217
Community Access Program, 14, 153
federally qualified health centers, 41,
122
local health departments, 64
study at hand, methodology, 19-20,
26-27
study at hand, sponsorship, 19
Uniform Data System, 19-20
uninsured persons, 174-175
Hispanics, 54
access to care, 175
uninsured, 34
Historical perspectives
community health centers, 73, 119-123
disabled persons, Medicaid
expenditures on, 184
disproportionate share hospitals. 40.
98-100
- -A -- - ~
HMO enrollment/profits, 16, 107,
110, 113, 171
homeless persons, 196-197
hospitals, 55, 112-113, 114-119
Medicaid coverage, 87-88, 91, 94-95,
98
Medicaid funding, 104
Medicaid market, 135, 171
school-based health centers, 69
uncompensated care costs and state/
local subsidies, 105
uninsured persons, 16-17, 40, 85-88,
120-121
HIV, see AIDS/HIV
Homeless persons, 21, 51, 195-198
local health departments, 64, 151
Hospitals and hospitalization, vii-viii,
113
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270
INDEX
academic medical centers, 4, 23, 24,
56,65-66,72,84,114,116-117,
135, 145, 146, 148-149, 161
administrative requirements, 145-146
208
AIDS/HIV patients, 193
charity care, 55, 65, 113; see also
"uncompensated care," infra
core safety net providers, 22, 23, 41,
105, 114-115, 118, 147-149
county-level support, 105
drugs, discounts, 91
financial performance, 114-119
historical perspectives, 55, 112-113,
114-119
HMO enrollment and admissions
trends, 107
homeless persons, 196
Indian Health Service, 69-70
local support, 103-106
Medicaid patients, 5, 19, 23, 36-37, 55,
114-119, 135, 147-149, 153
Medicare patients, 66, 98, 114, 116,
117, 119
mergers and consolidations, 16, 112-
113, 209
organizational factors, 83-84, 212
price competition, 19, 83
revenue sources, 55, 58, 114-119
rural areas, 116, 117
self-paying patients, 56, 55, 58, 59,
115, 118
study at hand, methodology, 22, 23,
24, 26
uncompensated care, 19, 40-41, 58-59,
65-66, 72, 105, 113, 115-119,
145, 147; see also
Disproportionate share
hospitals
uninsured patients, 1-2, 4-5, 24, 148-
149, 174-175
urban areas
financial situation, 115-117, 148
uncompensated care, 19, 41, 55,
58-59, 66, 72
Veterans Health Administration, 70
see also Academic medical centers;
Disproportionate share
hospitals; Emergency care;
Public hospitals
Human immunodeficiency virus, see
AIDS/HIV
I
Immigrants, vii, 21, 49, 53
local health departments, 64
Medicaid coverage, 39-40, 90, 92-93
uninsured, 89-90
see also Language barriers
Immigration and Naturalization Service,
40
Immunizations, 56, 57, 61, 64, 125, 164,
186
Indian Health Service, 69-70, 85, 213-214
Insurance, 16, 56, 57
Balanced Budget Act (BBA), 35
expansion efforts, 34-35, 85
Health Insurance Portability and
Accountability Act, 34, 95,
97(n.13)
medical savings accounts, 95
point-of-service plans, 106, 201
self-employed persons, 34, 95
special-needs patients, 51
unemployed persons, 34
see also Employer-sponsored
insurance; Fee-for-service
coverage; Health maintenance
organizations; Managed care;
Medicaid; Medicaid managed
care; Medical savings accounts;
Medicare; Risk-based coverage;
Uninsured / underinsured
persons
Integrated delivery systems, 42, 83-84,
208, 211-212, 215
federal safety net initiative, 152-153,
215
homeless persons, 197
horizontal, 82, 138-139
mental health, 189-190
special-needs patients, 186-187, 189,
190-191, 197, 201
vertical, 82, 145-146, 151-152
InterStudy, 106-107
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INDEX
Johns Hopkins University, 195
K
Kaiser Commission on the Future of
Medicaid, 37, 97(n.14)
Kaiser Family Foundation, 164
Kassebaum-Kennedy law, see Health
Insurance Portability and
Accountability Act
Kellogg Foundation, W.K., 175
L
Language barriers, 21, 24, 41, 48, 52, 53,
59, 73
Legislation
American Indian Self-Determination
Act, 60
Americans with Disabilities Act, 181,
182
Balanced Budget Act, 5, 12, 24, 34, 35-
37, 101-102, 103, 154, 211, 215
special-needs patients, 35, 182, 206
State Children's Health Insurance
Program (SCHIP), 11-12, 34, 40,
69, 92, 97-98, 215
Balanced Budget Refinements Act, 5-
6, 35, 101
Department of Health and Human
Services Appropriations Act,
153
FY 2000 Appropriations Act, 14
Health Insurance Portability and
Accountability Act, 34, 95,
97(n.13)
Omnibus Budget Reconciliation Acts,
30, 31, 98
Personal Responsibility and Work
Opportunity Reconciliation Act
(PWORA), 90, 92-93
Public Health Service Act, 20(n.2)
Ryan White CARE Act, 57, 62, 193
Social Security Act, 31
AFDC/TANF, 26, 92, 146, 147, 184
271
Title V, 12, 56, 64, 185, 186, 188
Stewart B. McKinney Homeless
Assistance Act, 197
The Lewin Group, 143-144, 190
Local areas, general, 211
core safety net providers, 54
neighborhood health centers, 73, 139
Neighborhood Health Plan, 138-139
uninsured persons, number of, 33-34
variations across, 28, 37
see also Community health centers
Local government, 10-11, 16, 56, 81, 210,
211, 213
core safety net providers, 23, 103-105,
113, 148
county-level efforts, 23, 56, 57, 64-65,
66,73,74,103,104-105
special-needs children, 187-188
grants from, 5, 6, 13, 49, 54-55, 122,
140, 151, 189, 196
Medicaid managed care, 7-8, 33, 42
monitoring information provided to,
12
organization of health delivery, 83-84
private takeovers of public hospitals,
113
tax base, 4, 6, 83, 113, 151
see also specific jurisdictions (e.g., New
York CityJ
Local health departments, vii-viii, 22, 62,
63-65, 212
AIDS/HIV patients, 64, 125, 151
children, 64, 124
fiscal viability, 123-126, 133
grants, 64, 151
HMOs and, 65, 124
homeless persons, 64, 151
managed care, general, 20, 151
Medicaid, general, 64, 124-126, 133
Medicaid managed care, 41, 123-124,
126, 141, 146-147, 150-152, 153
primary care, 124-125
sexually transmitted diseases, 64, 125
study at hand, methodology, 20, 27
uninsured patients, 53
Los Angeles, California, 23, 89
Low-income persons, see Poverty
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272
M
Mainstreaming, 26, 30, 38-39, 135, 170-
173, 176, 195
Making the Grade program, 69
Managed care, 10, 16, 56, 57, 132, 136-
152, 206
beneficiary choice, 7, 25, 30, 83-84,
166-170, 206-207
mainstreaming, 26, 30, 38-39, 135,
170-173, 176, 195
commercial managed care vs
Medicaid, 7, 19, 135, 161-162,
185
competition, 40, 41, 42, 106-107, 136,
140
price, 3, 19, 82, 83-84, 106, 153, 206
discounting, 40-41
employer-sponsored, 16, 67-68
local health departments, 20, 151
mandated, 6, 8, 31, 35, 36, 38, 42, 103,
133, 134, 145, 147, 150, 151, 165,
170, 209, 211
special-needs patients, 187, 194,
199
market penetration, 106-107
Medicare, 37
mental health, 189-191
minority physician participation, 68
organizational factors, 83
physicians and charity care, 6, 41,
107(n.30)
rural areas, 36, 57, 110, 139-140, 169
special-needs patients, 187, 194, 198,
199
study at hand, methodology, 18-19,
20,231
technical assistance for, 14, 217
urban areas, 68, 106-107
see also Health maintenance
organizations; Medicaid
managed care
Managed care organizations (MCOs), 42,
136
community health care centers and,
41, 137-139, 144
discounting, 40-41
federally qualified health centers and,
35, 36, 137-138, 142-143
INDEX
local health departments and, 151
Medicaid and, 33, 36, 108, 111, 137-
139, 142-143, 154
primary care case management, 31-
32, 139, 148, 149, 150, 162-163
risk-based plans, 32
rural areas, 149
state incentives, 154
urban/rural locations, 36, 37
see also Health maintenance
. .
Orgamzatlons
Market forces, 1, 9, 14, 15, 16, 74, 81, 83-
84, 175, 210
core safety net providers, 25, 71, 132-
133
hospital mergers and consolidations,
16, 112-113, 209
market share, 6, 16, 22, 106, 108, 112-
113, 132-133, 136
Medicaid, 25, 31, 33, 38-39, 82, 107-
112, 126, 134-152, 160, 161, 175,
170, 176, 206-207
regional variations, 22
special-needs patients, 13
see also Competition; Cost and cost-
effectiveness
Maryland, 173
Massachusetts, 138-139, 153-154, 188
MassHealth, 188
Maternal and Child Health Bureau, 64,
185
see also Title V (Social Security Act)
Mathematica Policy Research, Inc., 73,
141-143, 149-150
MDS Associates, 122
Medicaid, vii, 4, 6-9, 12, 20, 29-33, 212
accountability, 29, 107, 133
AIDS/HIV treatment, 192-194
Aid to Families with Dependent
Children/Temporary
Assistance to Needy Families
(TANF), 26, 92, 146, 147, 184
Balanced Budget Act
State Children's Health Insurance
Program (SCHIP), 11-12, 34, 40,
69, 92, 97-98, 215
Balanced Budget Refinements Act, 5-
6, 35, 101
charity care and, 6, 8, 40-41
OCR for page 273
INDEX
community health centers, 61, 62, 72-
73, 119-122, 138-139
competition, 25, 31, 38, 39, 126, 132,
170
core safety net providers, general, 49,
113-114
cost-based reimbursement, 5, 20(n.2),
24, 31, 35, 39, 40, 60
federally qualified health centers,
24, 35, 40, 71-72, 101-103
Rural Health Clinic program, 63
disproportionate share hospitals, 10,
18,29,36-37,40,49,98-101
(passim), 110, 126, 141, 174,
184, 213
Early and Periodic Screening,
Diagnosis, and Treatment
program, 56, 64-65, 126, 186
eligibility, 4, 7, 9, 29, 39-40, 87-88, 92,
101, 122, 132, 207
waivers, 30-32, 35, 71, 93-95, 103,
133, 134, 141, 146-147, 153-154,
160, 194-195
enrollment, 1, 6, 30, 34, 39, 50, 85, 87-
88, 92, 94-95, 185, 212
expansion, 26, 29, 31, 39, 41, 74
federally qualified health centers, 5,
31, 35, 36, 48, 54, 120-123, 133,
137-144, 153
fee-for-service coverage, 29, 31, 32,
35, 42, 110, 163
historical perspectives, 87-88, 91, 94-
95, 98, 104, 135, 171
HMO participation, 32, 38, 65, 109,
110, 111, 138-139, 146, 148, 149-
150,171
hospitals, 5, 19, 23, 36-37, 55, 114-119,
135, 147-149, 153
immigrants, coverage, 39-40, 90, 92-
93
local health departments, 64, 124-126,
133
mainstreaming, 26, 38-39, 176
managed care organizations and, 33,
36, 108, 111, 137-139, 142-143,
154
market forces, 25, 31, 33, 38-39, 82,
107-112, 126, 134-152, 160, 161,
170, 175, 176, 206-207
273
mentally ill patients, 188
provider participation, 51, 70
public hospitals, 55, 115, 118, 119, 135
reform, effects of, 5, 39, 65, 84-85, 90,
92-93, 173, 196
risk-based coverage, 29, 31-32, 110,
111, 154, 156
rural areas, 37, 57, 63, 67
state actuarial methods, 109-111
state administrative requirements, 18,
108, 132, 135, 145-146, 147, 150,
161, 172, 185, 208
state eligibility, enrollment and
benefits, 4, 7, 9, 30, 31, 37, 39,
90-91, 93-95, 96, 107, 109, 132,
168, 169-170
disabled persons, 184
mainstreaming, 26, 30, 38-39, 135,
170-173, 176
waivers, 30-32, 35, 71, 93-95, 103,
133, 134, 141, 146-147, 153-154,
160, 194-195
state government, market forces,
general, 38-39
state government, other, 29-42
(passim), 101-103, 210; see also
State Children's Health
Insurance Program
study at hand, methodology, 1, 18,
22, 23-24, 26
waivers, 30-32, 31, 35, 71, 93-95, 103,
133, 134, 141, 146-147, 153-154,
160, 194-195
Medicaid Access Study Group, 162
Medicaid managed care, 6, 9, 103, 107-
112, 126, 208-209, 211, 212
access to care, 161, 162-164, 170-173
AIDS/HIV patients, 194
Balanced Budget Act (BBA), 5, 12, 24,
34, 35-37, 211
beneficiary choice, 7, 25, 32, 33, 36,
37, 108, 109, 147, 159, 166-170,
206-207
mainstreaming, 26, 30, 38-39, 135,
170-173, 176, 195
capitation rates, 9, 30, 36, 38, 93, 109-
111,152,155,156,161,173,176,
209
OCR for page 274
274
INDEX
special-needs patients, 187-188,
192, 194-195
charity care and, 6, 8, 40-41
commercial managed care vs. 7, 19,
135, 161-162, 185
commercial plan participatin, 38-39,
109, 135, 171-172, 207
community health centers, 41, 133,
135, 136, 137-144
core safety net providers, 21, 25, 41-
43, 111-112, 126, 132, 134, 136-
152, 206-208, 209-210
costs and cost-effectiveness, 29, 30,
31, 32, 35-37, 43, 107, 135, 139,
140-141, 142, 143, 153
disabled persons, 182
enrollment in, 6, 41, 107-112, 205, 212
federal initiative, 215-216
federally qualified health centers,
122-123
Health Plan Employer Data and
Information Set, 164-165
historical perspectives, 29-32, 38, 39
implementation problems, 30, 165,
191, 208-209
local government role, general, 7-8,
33,42
local health departments, 41, 123-124,
126, 141, 146-147, 150-152, 153
managed care organizations and, 33, 36,
108, 111, 137-139, 142-143, 154
mandatory, 6, 8, 31, 35, 36, 38, 42,
103, 133, 134, 145, 147, 150, 151,
165,170,209,211
special-needs patients, 187, 194,
199
market forces, 25, 31, 38-39, 82, 107-
112, 126, 134-135, 170
mental health, 41, 182-183, 188, 189,
190-191
models of, 31-32
organizational factors, 25, 33, 82, 83
political factors, 29, 132, 160
primary care, 2, 17, 162-163, 164
public hospitals, 144-146, 147-148
quality assurance, 29, 36, 38-39, 42,
136, 162-166, 192
quality of care, 162-165
regional variations, 18
risk-based coverage, 29, 31-32, 110,
111, 154, 156
rural areas, 41, 67, 110, 139-140, 149-
150, 153
school-based health centers, 69
special-needs children, 181, 186, 187-
188
special-needs populations, 20, 26, 35,
170, 182-188, 190
capitation rates, 187-188, 192, 194-
195
state government, 107-111, 133-134,
138-139, 141, 142, 143, 151, 152,
153-156, 159-160, 163, 164, 165-
170,198,208,209
AIDS/HIV patients, 194-195
disabled persons, 182-183
mentally ill persons, 190-191, 192
special-needs children, 187-188
study at hand, methodology, 2, 8, 17,
22, 23-24, 26, 229-231, 250-251
Supplemental Security Income
recipients, 12
uninsured/underinsured persons, 7,
8, 29, 109, 111-112, 159-160,
206-208, 213
urban areas, 107-108, 110, 148
Medically underserved areas (MUAs), 5,
21, 53-54, 60
Medical savings accounts, 95
Medicare, 5, 206, 210
academic health centers, 66
academic medical centers, 106
AIDS/HIV treatment, 192, 193
Balanced Budget Act, 35, 142
core safety net providers, 42, 55, 56,
57,58,60,61,62
disabled persons, 182
disproportionate share hospitals, 10,
40, 56, 98(n.18), 100, 213
federally qualified health centers, 31,
60, 62, 102-103, 120, 142
hospitals, 66, 98, 114, 116, 117, 119
managed care plans, general, 37
mentally ill persons, 189
rural areas, 63, 140
upper limit payment, 98
urban areas, 56
waivers, 103
OCR for page 275
INDEX
Medicare Payment Advisory
Commission (MedPAC), 11,
214
Mental health and illness, 20, 51, 181,
188-192
homeless persons, 196, 197
Medicaid managed care, 41, 182-183,
188, 189, 190-191
public hospitals, 72
substance abuse, 53, 196, 197
Miami, Florida, 83, 89, 174
Michigan, 153
Migrant health care, 20, 57, 60(n.5), 61,
102, 121, 186, 225
Minnesota, 153, 169, 173
Minority groups, vii, 1, 24, 49, 52, 68
African Americans, 40, 54, 73, 193
Hispanics, 34, 54, 175
Native Americans, 35, 60, 69-70, 85,
103, 213-214
physicians of minority status, 68
uninsured, 16-17, 34, 40, 52
see also Immigrants
Missouri, 112, 169
N
National Academy for State Health
Policy, 37, 153
National Association of City and County
Health Officials, 124
National Association of Community
Health Centers, 102
National Association of Public Hospitals
and Health Systems (NAPH),
48, 54, 59, 104, 105
National Health Interview Survey, 73
Native Americans, 35, 60, 103
Indian Health Service, 69-70, 85, 213-
214
Neighborhood health centers, 73, 139
Neighborhood Health Plan, 138-139
New Jersey, 153-154
New York City, 23, 72, 91, 140-141, 147,
163, 168, 170
New York State, 153, 169, 250
North Carolina, 139-140
275
o
Ohio, 169
Omnibus Budget Reconciliation Acts, 30,
31,98
Oregon, 94, 95, 141, 160, 172-173
Organizational factors, 17, 24-25, 81-84,
155
barriers to access to care, 24
community health centers, 83, 84, 212
core safety net providers, 24-25, 38,
54-55, 56-57, 62, 74, 75
hospitals, 83-84, 212
Medicaid managed care, 25, 33, 82, 83
Medicaid market, 38, 108-109, 161
patchwork, 9, 17, 54-55, 56-57, 62, 75,
210, 211-212
physician supply, 74
tracking of delivery systems, 10-11,
36, 210-211, 213-215
uninsured persons, 82-83, 84
see also Administrative requirements;
Integrated delivery systems
Outcomes, health
academic health centers, 148
community health centers, 73
low-income persons, 14, 74, 216
Medicaid managed care, 163
nonmedical factors, 217
pregnancy, 163
prisoners, 191
special-needs patients, 191, 192, 200
tracking, 12, 13, 71, 215, 216
uninsured persons, 1-2, 13, 173
Outpatient care, see Ambulatory care
Outreach, 7, 13, 34, 48, 51, 57, 61, 74, 95,
97, 109, 166, 168, 208
special-needs patients, 181, 195, 197,
198, 199, 218
see also Advocacy
p
Peer review, methodology of study at
hand, viii, xiii-ix, 18, 27
Personal Responsibility and Work
Opportunity Reconciliation Act
(PWORA), 90, 92-93
OCR for page 276
276
Pharmaceuticals and pharmacists, 51, 57,
61,68,70,161,189,193
AIDS/HIV treatment, 193
costs and underinsurance, 91
immunizations, 56, 57, 61, 64, 125,
164, 186
mentally ill patients, 189
Philadelphia, Pennsylvania, 83-84
Physicians, 61, 74
charity care, 6, 24, 67-68
gag rules, 36
managed care, impact on charity
care, 6, 41, 107(n.30)
minority, 68
rural areas, 54
Picker-Commonwealth Fund, 73
Point-of-service plans, 106, 201
Political factors, vii, 4, 47, 103-104
Medicaid managed care, 29, 132, 160
regional variations, 22
Poverty, vii, 1, 3, 4, 24, 28, 47-48, 49-50,
200, 217
AIDS/HIV patients, 193
community health centers, 59, 72
disabled persons, 32
elderly persons, 32
INDEX
Preventive health interventions, 141,
151-152, 161, 162, 175, 208
AIDS/HIV, 186
children, 164
community health centers, 59, 61
disproportionate share hospitals, 100
immunizations, 56, 57, 61, 64, 125,
164, 186
Indian Health Service, 70
special-needs patients, 196
Primary care, 2, 7 17, 23
community health center/managed
care organization partnerships,
41
core safety net providers, 4
homeless persons, 197
local health departments, 124-125
Medicaid managed care, 2, 17, 162-
163, 164
Medicaid reimbursement, 32
safety net providers, 36
Primary care case management, 31-32,
139, 148, 149, 150, 162-163
Primary Care Development Corporation,
140-141
Prisoners 191
,
federal poverty level, 29, 33, 58, 67, 86 Private practitioners, 67-68
(n.3), 87-88, 97, 133 access to, 162
homeless persons, 21, 51, 64, 151, 180,
195-198
mandatory care, general, 54
medically underserved areas, 5, 21,
53-54, 60
organization of health care, 83-84
privately insured poor persons, 164
regional variations in care, 22
underinsured /uninsured, 1, 21, 86-
87, 173-175, 216
see also Aid to Families with
Dependent Children;
Medicaid; Medicaid managed
care; Temporary Assistance to
Needy Families
Pregnant women, 29, 62, 74, 149, 162,
163, 172
President's Advisory Commission on
Consumer Protection and
Quality in the Health Care
Industry, 214
charity care, 6, 17, 24, 41, 67-68
gag rules, 36
Medicaid patients, 67, 68, 74
minority, 68
rural areas, 54, 67-68
uninsured patients, 24, 67, 68
Provider-sponsored organizations, 37,
142
Public health, 14, 56, 212, 251-252
see also Local health departments
Public Health Service Act, 20(n.2)
Public hospitals, 55, 58-59, 74
AIDS/HIV patients, 72
ambulatory care, 25, 55, 58
core safety net providers, 4-5, 22, 23,
47-48, 55, 58-59, 147-148
disproportionate share hosnitals.17.
40
- -r ~
drugs, discounts, 91
financial performance, 114-118, 144-
145
OCR for page 277
INDEX
homeless persons, 197
Medicaid managed care, 144-146,
147-148
Medicaid patients, 55, 115, 118, 119,
135
Medicare revenues, 119
mental health, 72
National Association of Public
Hospitals and Health Systems
(NAPH), 48, 54, 59, 104, 105
organizational factors, 83, 212
private acquisition of, 112-113
professional education provided by,
48
rural areas, 54
self-paying patients, 55, 58, 59, 115,
118
special-needs patients, 72
teaching hospitals, 48, 148, 161
uninsured patients, 55, 56, 58, 59, 174-
175
urban areas, 55, 72
Q
Quality Improvement System for
Managed Care, 165
Quality of care, 13, 27, 155, 162-164, 176
federal monitoring of delivery
systems, 10-12, 36, 210-211,
213-215
local health department role, 63-64
Medicaid managed care, 29, 36, 38-39,
42, 136, 162-166, 192
mental health, 192
protocols, 136, 211
see also Accountability; Outcomes,
health
R
Race/ethnicity, see Immigrants; Minority
groups
Regional factors, 22, 63, 211
study at hand, methodology, 18, 249-
257
see also Geographic factors; State-level
trends
277
Rhode Island, 133, 147, 160, 163, 197
Risk adjustment, 111, 136, 141, 162, 173,
209
special-needs patients, 185, 191-192,
194-195, 199
Risk-based coverage, 16
adverse risk selection, 12, 148, 194,
215
Medicaid, 29, 31-32, 110, 111, 154, 156
Risk pools, 194, 195, 199
Robert Wood Johnson Foundation, 69,
175
Rural areas, vii, 4, 28, 53-54
community health centers, 28, 54, 62-
63
employer-sponsored insurance, 67-68
federally qualified health centers, tax-
exempt, 60-61
funding sources for safety net
providers, 55, 57
hospital financial performance, 116,
117
managed care organizations, 36, 37,
149
Medicaid, general, 37, 57, 63, 67
Medicaid managed care, 41, 67, 110,
139-140, 149-150, 153
Medicare, 63, 140
private practitioners, 54, 67-68
Rural Health Clinic program, 62-63
study at hand, methodology, 18, 258-
259
Rural Health Care Group, 139-140
Ryan White CARE Act, 57, 62, 193
S
Safety Net Organizations and Patient
Advisory Commission
(proposed), 11-12
San Diego, California, 23
San Francisco, California, 62
School-based health centers, 5, 64, 65, 69,
70, 146, 151, 152, 186
Section 1115 waivers, 30, 31, 35, 71, 93-
95, 103, 133, 141, 146-147, 153-
154, 160, 194-195
Self-employed persons, 34, 95
OCR for page 278
278
Self-paying patients, 56, 55, 58, 59, 61,
115, 118
see also Uninsured/underinsured
persons
Sexually transmitted diseases, 53, 64, 125
see also AIDS/HIV
Social factors, 4, 159
homeless persons, 21, 51, 64, 151, 180,
195-198
regional variations, 22
risk factors, 161
see also Cultural factors; Demographic
factors
Social Security Act, 31
Aid to Families with Dependent
Children, 26, 92, 146, 147, 184
Title V, 12, 56, 64, 185, 186, 188
Social Security Disability Insurance, 192
Special health care needs, vii, 1, 21, 26,
51
access to care, 13, 51, 195, 197, 198,
199, 218
outreach, 181, 195, 197, 198, 199,
218
accountability, 199, 201
advocacy, 199-200
Balanced Budget Act (BBA), 35, 182,
206
definitional issues, 181-182, 198
cost-based payment, 72 - - r - r -
costs and cost-effectiveness issues, 98-101, 110
188, 192-194, 199, 200
county-level efforts, 187-188
extent of, 181-182
HMOs, 187
homeless persons, 21, 51, 64, 151, 180,
195-198
integrated delivery systems, 186-187,
189, 190-191, 197, 201
local health departments, 53
managed care, mandated, 187, 194,
199
INDEX
preventive health interventions, 196
risk adjustment, 185, 191-192, 194-
195, 199
risk pools, 194, 195, 199
state government, 198, 199
AIDS/HIV patients, 194-195
disabled persons, 182-183
medical necessity laws, 199
mentally ill persons, 190-191, 192
special-needs children, 187-188
urban areas, 56
see also AIDS/HIV; Chronically ill
persons; Disabled persons;
Mental health and illness
Special-needs children, 20, 181, 185-188
AIDS/HIV patients, 194
Balanced Budget Act (BBA), 35
Special Supplemental Nutrition Program
for Women, Infants, and
Children, 56, 57, 64
SSI, see Supplemental Security Income
State Children's Health Insurance
Program (SCHIP), 11-12, 34, 69,
97-98, 215
immigrants, 40, 92
State government, 16, 81, 153-156, 211
Balanced Budget Act (BBA), 35, 101-
103; see also State Children's
Health Insurance Program
disproportionate share hospitals, 40,
federally qualified health centers,
support for, 101-103, 153
grants from, 5, 6, 13, 49, 54-55, 56, 57,
122, 140, 151, 189, 196
homeless persons, 196
insurance premium limits, 95
Medicaid actuarial methods, 109-111
Medicaid administrative
requirements, 18, 108, 132, 135,
145-146, 147, 150, 161, 172, 185,
208
Medicaid managed care, 20, 26, 35,
170, 182-188, 190
capitation rates, 187-188, 192, 194-
195
outcomes, health, 191, 192, 200
outreach, 181, 195, 197, 198, 199, 218
Medicaid eligibility, enrollment, and
benefits, 4, 7, 9, 30, 31, 37, 39,
90-91, 93-95, 96, 107, 109, 132,
168, 169-170
disabled persons, 184
mainstreaming, 26, 30, 38-39, 135,
170-173, 176
OCR for page 279
INDEX
waivers, 30-32, 35, 71, 93-95, 103,
133, 134, 141, 146-147, 153-154,
160, 194-195
Medicaid managed care, 107-111,
133-134, 138-139, 141, 142, 143,
151, 152, 153-156, 159-160, 163,
164, 165-170, 198, 208, 209
AIDS/HIV patients, 194-195
disabled persons, 182-183
mentally ill persons, 190-191, 192
special-needs children, 187-188
Medicaid market, general, 38-39
Medicaid, other, 29-42 (passim), 101-
103, 210; see also State
Children's Health Insurance
Program
monitoring information provided to,
12
provider-sponsored organizations, 37
school-based health centers, 69
special-needs patients, 198, 199
AIDS/HIV patients, 194-195
disabled persons, 182-183
medical necessity laws, 199
mentally ill persons, 190-191, 192
special-needs children, 187-188
State Children's Health Insurance
Program, 11-12, 34, 40, 69, 92,
97-98, 215
uninsured, 84, 173, 174-175
State-level trends
data variability across states, 27, 210
immigrants, uninsured, 90
uninsured persons, number of, 33, 34,
89-91
see also Regional factors; specific states
Stewart B. McKinney Homeless
Assistance Act, 197
Subsidies, 4, 13, 28, 205, 213, 216
core safety net providers, 4, 10, 17,
23, 25, 40-42, 49, 209-210
graduate medical education, 28, 106
Medicaid, 5, 33, 39
organization of delivery service, 83
phaseout, 6, 8, 10, 17, 40-41
rural areas, 28
uncompensated care costs and state/
local subsidies, trends, 105
279
see also Disproportionate share
hospitals; Federally qualified
health centers; Grants
Substance abuse, 53, 196, 197
Substance Abuse and Mental Health
Services Administration, 14,
190, 213, 217
Supplemental Security Income, 12, 184,
188, 190
Taxation
deductions for self-employment
insurance coverage, 95
disproportionate share hospitals, 99
employer-sponsored insurance, 34-35
federally qualified health centers, tax-
exempt, 60
local government, 4, 6, 83, 113, 151
private takeovers of public hospitals,
113
state, 141
uninsured, coverage for, 174
Technical assistance, 11, 14, 140, 143,
171,214,217
Telephone services, 14, 161, 217
Temporary Assistance to Needy
Families (TANF), 26, 146, 147,
184
Temporary Emergency Food Assistance
Program, 197
TennCare, 95, 111, 133-134, 148, 160, 162,
191, 194, 195
Tennessee, 94-95, 133, 147, 160, 194
Texas, 112, 148
Title V (Social Security Act), 12, 56, 64,
185, 186, 188
Training, see Education and training,
professional
Transportation to care, 7, 21, 48, 56, 59,
137,161,163,166,185,197
U
Uncompensated care, 3, 6, 28, 126, 206
core safety net providers defined, 21-
22, 90
OCR for page 280
280
HMOs and, 107
hospitals, 19, 40-41, 58-59, 65-66, 72,
105, 113, 115-119, 145, 147; see
also Disproportionate share
hospitals
private practitioners, 67
state variations, 90-91
see also Charity care;
Disproportionate share
providers, general
Unemployed persons, 34, 51
Uniform Data System, 19-20
Uninsured/underinsured persons, 1-3, 4,
9, 21, 84-93, 126, 173-175, 205-
206, 212-213
African Americans, 40
children, 133
community health centers, 59, 62
core safety net providers, 3-4, 5, 21-
24, 27-28, 47-48, 50, 55, 56, 58,
59, 209
definition of, 85
discounting under managed care, 40-
41
emergency care, 1-2, 65
federally qualified health centers, 5,
52, 61, 119-122 (passim)
geographic variation, 84
historical perspectives, 16-17, 40, 85-
88, 120-121
hospitals, 1-2, 4-5, 24, 148-149, 174-
175
HRSA, 174-175
immigrants, 89-90
length of time uninsured, 89, 207
local health departments, 64-65
mainstreaming, 26
Medicaid managed care and, 7, 8, 29,
109, 111-112, 159-160, 206-208,
213
minority groups, 16-17, 34, 40, 52
number of, vii, 1, 5, 8, 16-17, 33-34, 50,
84,85,173,210
organization of health care, 82-83, 84
private practitioners, 24, 67, 68
public hospitals, 55, 56, 58, 59, 174-
175
Rural Health Center program, 63
self-employed persons, 95
INDEX
self-paying patients, 56, 55, 58, 59, 61,
115, 118
state government role, 84, 173, 174-
175
workers, 86-87, 173
see also Charity care;
Disproportionate share
hospitals; Disproportionate
share providers, general;
Uncompensated care
University of California, 74
Urban areas, vii, 4, 23, 28, 53-54
ambulatory care clinics, 22
federally qualified health centers, tax-
exempt, 60-61
funding sources for safety net
providers, 55, 56
hospitals,
financial situation, 115-117, 148
uncompensated care, 19, 41, 55,
58-59, 66, 72
local health departments, 124-125
managed care, 68, 106-107
Medicaid managed care, 107-108, 110,
148
Medicaid patients, 37, 55, 56
minority physicians, 68
private practitioners, 67-68
public hospitals, 55, 72
school-based health centers, 69
see also specific cities
Urban Institute, 100, 106, 143, 153
V
Veterans Health Administration, 69-70
see also Department of Veterans
Affairs
W
Waivers, 30-32, 35, 71, 93-95, 103, 133,
134, 141, 153-154, 160, 194-195
Washington State, 138, 146, 153, 160, 169,
173
Welfare, see Aid to Families with
Dependent Children;
Medicaid; Supplemental
OCR for page 281
INDEX
Security Income; Temporary
Assistance to Needy Families
Welfare reform, 5, 39, 65, 84-85, 90, 92-
93, 173, 196
Wisconsin, 163-164
"Wrap-around" services, 48
Women, 32, 56, 74, 114-115, 133
community health centers, 73
homeless persons, 196
local health departments, 124
pregnant, 29, 62, 74,149,162,163,172
281
Title V (Social Security Act), 12, 56,
64, 185, 186, 188
see also Family planning
Workers
low-income, 86-87
self-employed, 34, 95
unemployed, 34, 51
uninsured, 86-87, 173
see also Employer-sponsored
insurance
Representative terms from entire chapter:
medicaid managed
