Toward implementation of an urban health agenda: the role of government.

Government has several essential roles in the implementation of an urban health agenda. Government acts as a direct agent in the financing and delivery of services, as a rule maker for the financing and provision of care by others, and as a forum for political debate. Discussions of access to care, control of health care costs, and the maintenance of quality all include a role for government. A period of apparent rejection of comprehensive governmental health care policy has nevertheless included numerous examples of the persistence of government's many roles.

A federal/state partnership for health system reform.

In view of the continued lack of consensus regarding health system reform, a new approach is needed to the pluralism that characterizes the U.S. political scene. A two-step strategy can help to break the deadlock around health care financing and provision: a framework around which to shape federal/state responsibility for health care and a process to ensure that policy is translated into action. This strategy, called a federal/state compact for health, builds on actions already under way in several states and represents a process that is both incremental and comprehensive in nature. The federal government would take the lead regarding policy making, financing, and establishing benefits. The states would administer the program with flexibility similar to that existing in Canada's provinces.

A report from the front line: policy & politics in health reform.

With federal action on health care reform at a standstill, states are faced with the choice of waiting for Washington or moving ahead. But states will have a hard time taking action in the face of economic problems and the need for additional revenues to address the problems of the uninsured. Grass roots advocacy is essential to put health care reform on the political agenda at all levels. Key elements of reform include allocating responsibility for payment and establishing methods of cost control. States have achieved limited success in controlling costs and expanding access but a federal framework is necessary if real progress is to be made.

A state legislator's perspective on health policy in the 1990s.

The majority leader of the New York State Assembly says state legislatures can play an important role in working with the public and the federal government in developing an effective health care system.

Changing patterns of health insurance coverage: special concerns for women.

Health care expenditures and utilization have increased dramatically in recent years, but gaps in health insurance coverage restrict access to care for a growing portion of the population. Women are especially vulnerable given the structure of insurance coverage and demographic factors. The erosion of insurance coverage can be attributed to several trends, particularly employer cost containment strategies, restricted public program eligibility and changes in the characteristics of the work force. Numerous measures have been adopted at the federal and state levels to maintain or expand coverage on an incremental basis. As broader segments of the population suffer reduction or loss of coverage, a comprehensive approach will be necessary to ensure universal access to health care.