Disparities in health outcomes for low-income populations as documente
d by rates of preventable hospital admissions remain large in the Unit
ed States, even with the moderate expansion of Medicaid and efforts at
the state and local levels to improve primary care services that bega
n in the mid-1980s. These differences in outcome for rich and poor are
not an isolated phenomenon of a few old and decaying Northeast urban
centers but are documented in a broad range of urban areas. Much small
er differences are found in urban areas in Ontario, where universal co
verage may help to reduce barriers to care.