For several years, health care in the United States has been a critical, contentious, and pervasive issue of public and private sector policy, confronting not only national, state, and local governments but corporate management, labor unions, and other segments of the national economy. In the 1990s, it is a serious and omnipresent personal issue facing most Americans and their families. Three major aspects of the health care system present serious problems: high and escalating costs, including those for insurance coverage; access -- informational, financial, physical, and professional (e.g., willingness of hospitals and/or doctors to treat); and health practices and behaviors of individuals and families.
Another aspect -- health care quality -- has been largely positive, despite its unevenness among geographic areas and categories of persons served. The notable achievements of American medicine are indisputable. The United States continues to attract many persons from the rest of the world. Medical students and practitioners are drawn to our teaching hospitals and medical schools to learn advanced procedures, and public and private officials from abroad travel across the nation, learning about innovative medical and health care methods. Americans not only are grateful for computerized axial tomography (CAT) scans, magnetic resonance imaging (MRI), sonograms, and other marvels, but when surveyed in opinion polls, typically express satisfaction with the care they themselves receive. A 1990 Gallup Poll showed a 92 percent excellent or good rating for the respondents' family physician, but 56 percent of the same respondents characterized the U.S. health care system as fair or poor! 1
For the at-risk population with which this book is concerned, problems of access, cost, client behavior, and motivation became increasingly serious through the 1980s and early 1990s. The 1991 report of the National Commission on Children (NCC) stated:
Perhaps no set of issues moved members of the . . . Commission more than the wrenching consequences of poor health and limited access to medical care. In urban centers and