Equity,access, and outcomes: The status of the art

A rationale for including analyses of outcome in evaluation of the impact and equity of changes in health care policy for the poor is presented. We first discuss problems in defining equity in and access to health care. Equity in access to health care requires equality of access only to those services that are believed to be efficacious. Three cost-containment strategies (restrictions in eligibility, coinsurance, and capitation) are then examined, and their limitations are discussed. Finally, directions for future research focusing on outcomes are suggested. Rather than using access to care to assess outcome, outcome is viewed as the framework for assessing access and equity.     

The Role of Class Action Litigation in Achieving Child Welfare Reform: A Study in Public Conflict Resolution

This article traces the history of a 16-year court battle over the child welfare system in Kansas City, Missouri, which eventually headed toward resolution as the result of an innovative public policy negotiation process. The process combined the substantive expertise of nationally and locally respected child welfare professionals with political muscle at the state, local, and community levels to develop and implement a plan for reform. If the results of this process become institutionalized in the Kansas City child welfare system, it will represent a significant transformation in the governing culture and practices of the system and the community it serves.