Health care for the poor.

In the 1980s the convergence of a number of factors is causing government at all levels, industry, and labor to plan or initiate major reductions in health spending. Important among these are rising health care costs, a troubled national economy, mounting federal deficits and state revenue shortfalls, and the philosophical course and domestic policy of the Reagan administration. In this context government has been rethinking its capacity to finance health services for the poor, and new and sometimes controversial arrangements for delivering these services are being developed. The dilemma government officials face now is how to cut costs while still assuring that quality medical services are available. This article focuses on what these new policy developments and arrangements are and whether the significant gains in access and in health achieved over the past 20 years will be sustained. Because truly sweeping reforms are unlikely, whether government will maintain earlier commitments and established arrangements for financing and delivering health services to the poor will be worked out piecemeal over the next several years.