Equity, access, and the costs of health services

Access to health care services for the poor and elderly have improved dramatically over the last 15 years, largely as a result of Medicare, Medicaid, and other Federal initiatives. The poor now consume roughly the same volume of health services as the nonpoor. Yet there are still substantial access barriers for many of the chronically ill, minorities, and residents of inner cities and rural areas. Of broader concern, the improvements in access are now threatened by the response to rising health care costs. Those cost increases are themselves partly--but only partly--attributable to Medicare and Medicaid themselves. True cost containment, as opposed to program cost containment, can restrain cost increases without damaging access, but is politically more difficult to accomplish than measures to reduce access.