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National Initiatives for Care of the Medically Needy

James E. Davis, MD
JAMA. 1988;259(21):3171-3173. doi:10.1001/jama.1988.03720210061031.
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THE PROVISION of medical care to the underserved, the underprivileged, and the financially needy is a compelling concern of medicine, perhaps the most perplexing problem that confronts the medical profession today.1 The need to ensure access to care for all those in need has been exacerbated by the economy, a competitive health care environment, and an escalating national debt. The potential bankruptcy of the Medicare Hospital Trust Fund, with commensurate cuts in reimbursement for services, has contributed to the increasing number of people who cannot obtain preventive and acute care services. This is in an era in which American medicine sets the standard for health care in the world.2 Organized medicine is meeting this challenge to provide care for the medically poor.

Historical Perspectives  Historically, care of the poor was the responsibility of charitable institutions. Early in this century the report by Flexner,3 commissioned by the American


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