Charity care: a proposal for reform

Changing political attitudes and new financing trends jeopardize our commitment to providing equitable access to medical services for all citizens regardless of ability to pay. The commitment is further threatened by the lack of coordination and the fragmentation that make charity care expensive and ineffective. This article proposes that we bring continuity and consistency to our charity care efforts by considering four options for reform: reallocate health spending to emphasize primary, preventive care in the community setting: create special HMOs for the medically disadvantaged through a revitalized community health center program; develop a voucher program to ensure access to the HMOs as well as risk-sharing pools to ensure access to secondary and tertiary care; and radically restructure the public hospital systems and eliminate most hospitals in the veterans administration system.