TOWARD A NEW URBAN HEALTH MODEL - MOVING BEYOND THE SAFETY NET TO SAVE THE SAFETY NET - RESETTING PRIORITIES FOR HEALTHY COMMUNITIES

Parkland Health and Hospital System has been successful by every measu re of comparison among its peer institutions, yet it recognizes the im perative of adapting to changes in the regulatory, legislative, and ma rket environments. Given its mandate and a desire to preserve its mult iple missions and its partnerships with a highly rated medical school, the playing field for achieving robust survival is very uneven. This article describes the evolution of one of the best ''sick care systems '' in the United States into an integrated, excellent health care syst em for the 21st century. The problems faced by the safety net in many urban areas of this country are similar. Many problems are structural in nature and will, therefore, require structural solutions at the loc al, state, and national levels. Parkland will continue and will be nee ded for many years as the tertiary and quaternary center of a comprehe nsive service network made up also of a series of outreach Community O riented Primary Care clinics and special populations projects. In addi tion, we hope to help create a community-oriented managed-care plan th at encompasses the desire to work with both denominator and numerator populations in a real partnership with many other stakeholders.