THE MISSING VOICE - IMPACTS OF HEALTH SYSTEM CHANGE ON LOW-INCOME COMMUNITIES

Unique problems in obtaining adequate health care face poor urban comm unities. These include the rising number of uninsured, abuses in the m anaged-care system, the unwillingness of private providers to deliver health care for either Medicaid recipients or the uninsured, and an in sufficient supply of primary care physicians in minority neighborhoods . If the managed-care system is to bring decent health care to poor ur ban communities, it must avoid the mistakes of the past. The health ca re system must be community based, oriented toward primary care, suffi ciently funded, and universally accessible. There needs to be better c oordination between medical schools and community health requirements and better support for public health facilities. Without adequate heal th care for the poor, urban living will eventually become more onerous for all.