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The fundamental problems that beset the U.S. health care system--cost, quality, and access--differ in scope and intensity in inner cities. Current trends in health care are systemwide but are more difficult to accommodate in inner cities because of scarce resources and stresses to the health care system. In this position paper, the American College of PhysiCians seeks to highlight directions and innovations in public policy for inner-city health care with renewed determination that health care problems in the United States must be solved, especially in cities, where they are most extreme. Many persons in inner cities experience an urban health penalty because of the concentration of economic decline, job loss, and major health problems. Because the problems originate in a complex interaction of socioeconomic factors, behavior, environment, and disease that is related to race and ethnicity, multifaceted approaches that extend beyond the medical model are needed to improve health status. The College argues for tackling health problems of the inner city in the context of a comprehensive urban policy that addresses the root: causes of poverty. In addition, this position paper contains more specific recommendations to improve health care delivery to inner cities. The College calls for a comprehenSiVe urban partnership initiative to address all aspects of the urban penalty-social, economic, and health-related--and recommends solutions through public and private collaborations that can be adapted to the circumstances of each Community in addition, policy recommendations address health care coverage, providers, public hearth initiatives, community involvement, and short-term improvements to such existing programs as Medicaid. [ABSTRACT FROM AUTHOR]

Abstract: The quality of ambulatory care received by Medicare recipients who enrolled in health maintenance organizations (HMOs) was compared to the care received by fee-for-service (FFS) Medicare recipients, in a quasi-experimental, non-randomized design. Both samples were drawn from the four major geographic areas in the country, and included two types of HMO practices: staff/group models, and independent practice associations (IPAs). A panel of expert physicians developed criteria for evaluating ambulatory care, and medical record abstractions using these criteria were performed on 1,590 outpatient records: 777 FFS and 813 HMO (441 staff/group, 372 IPA). While individual items of medical histories and physical examinations were performed most often for staff/group HMO patients and least often in FFS patients, odds ratios (OR) for performance in staff/group HMO patients were particularly large for health maintenance items: tonometry (OR = 8.4), mammography (OR = 2.7), pelvic examination (OR = 5.3), rectal examination (OR = 2.9), fecal occult blood test (OR = 3.3). The results suggest that recommended elements of routine and preventive care are more likely to be performed for Medicare enrollees in staff/group HMOs than in FFS settings. (Am J Public Health 1990; 80:411-415.) [ABSTRACT FROM AUTHOR]

The article focuses on the implications of a medical service known as contract or lodge practice to the health insurance in the U.S. In a lodge practice, a medical practitioner agrees to provide medical service to group of patients, such as members of benevolent organizations, fraternal lodges, or employees of industrial companies, for a fixed remuneration per year. It has been noted that this form of medical practice usually leads to substandard applications because some of the physicians provide slipshod services. They are pursuing this service as a means of obtaining a reputation and a clientele. The prevalent practice of these physicians was rooted from the point of view of a practitioner who felt exploited and threatened economically, particularly by the health insurance.