Tying a knot in the unraveling health care safety net

The U.S. health care system continues to rely on a diverse and poorly organ ized health care safety net to provide care for its uninsured and underinsu red residents. Last year, the Institute of Medicine (IOM) published a repor t entitled America's Health Care Safety Net: Intact but Endangered. The IOM cited seveal threats to the safety net, including inadequate monitoring of safety net function, poor integration of services, financial threats for c ore safety net providers, and the destabilizing effects of a rapid shift fr om traditional Medicaid to Medicaid managed care products. This paper revie ws the findings of the IOM report, highlighting the key issues for emergenc y medicine. In response to the IOM's challenges, emergency departments shou ld be used more effectively to monitor local safety net viability and to en hance the integration of community health care safety net delivery systems.