ACADEMIC MEDICAL-CENTERS AND THE CARE OF UNDERSERVED POPULATIONS

As the number of Americans at risk of being underserved continues to r ise, a better understanding of safety-net providers of health care is needed to help ensure continuing care for the underserved. In this art icle, the authors have begun the process of defining the role of acade mic medical centers (AMCs) as a group in the care of those persons mos t at risk of being underserved-the medically indigent and members of m inority and poor populations-by quantifying the amount of inpatient ca re that AMCs provide to these individuals. The study went beyond previ ous work by using nationally representative sources of data (from 1989 to 1994) and by examining more than one underserved population rather than only the medically indigent. The study focused on AMCs and other hospitals in urban areas and excluded hospitals in rural areas. The d etailed findings confirm previous observations that urban AMCs of all types provide a large and disproportionate share of care for the medic ally indigent and the underserved members of minority and poor populat ions and that members of these populations constituted the majority of patients cared for in many AMCs in recent years. The findings show th at the proportion of patients from underserved groups admitted to all urban hospitals is rising and that this growth is faster among AMCs th an other hospitals. The authors comment that AMCs, because of their pr ominent and historical role in caring for the underserved, have the op portunity to lead efforts to continue such service through innovative approaches to health care and the prevention of illness. Whether AMCs can seize this opportunity when confronted by price competition and go vernment policies that reduce AMCs' capacity to care for the underserv ed remains to be seen.