This volume reports the different ways in which various urban academic health centers are seeking to reposition themselves in order to protect and advance their primary missions of education, biomedical research, and sophisticated patient care.

Originally published in 1986 Urban Hospital Location examines the rising costs of health care and how the problem of providing a cost-effective and equitable pattern of health services is now a vital issue in many countries. It looks at how location decisions are especially difficult in cities because of the shifting geographical distribution and demographic structure of urban populations. The book shows how the utilisation of health services is strongly influenced by their location and argues that better geographical organisation of health care facilities would contribute significantly to a better and more effective health service.

Academic health centers (AHCs) have played a key role in propelling the United States to world leadership in technological advances in medicine. At the same time, however, many of these urban-based hospitals have largely ignored the medical care of their poor neighbors. Now one of the leading experts in American health policy and economics ponders whether current and proposed changes in the financing and delivery of medical care will result in a realignment between AHCs and the poor. Basing his discussion on an analysis of the nation’s twenty-five leading research-oriented health centers, Eli Ginzberg and his associates trace the history of AHCs in the twentieth century. He claims that AHCs are once again moving toward treating the poor because these hospitals need to admit more Medicaid patients to fill their empty beds, and their medical students need opportunities to practice in ambulatory sites. He also assesses some of the more important trends that may challenge the AHCs, including financial concerns, changing medical practice environments, and the likelihood of some form of universal health insurance. Eli Ginzberg is director of The Eisenhower Center for Conservation of Human Resources, Columbia University. He has been a consultant to nine U.S. presidents and chaired the National Commission for Employment Policy for six presidents. He is the author of numerous books as well as articles on health affairs in the New England Journal of Medicine, the Journal of the American Medical Association, and many other journals.

In 1996, the Institute of Medicine (IOM) released its report Telemedicine: A Guide to Assessing Telecommunications for Health Care. In that report, the IOM Committee on Evaluating Clinical Applications of Telemedicine found telemedicine is similar in most respects to other technologies for which better evidence of effectiveness is also being demanded. Telemedicine, however, has some special characteristics-shared with information technologies generally-that warrant particular notice from evaluators and decision makers. Since that time, attention to telehealth has continued to grow in both the public and private sectors. Peer-reviewed journals and professional societies are devoted to telehealth, the federal government provides grant funding to promote the use of telehealth, and the private technology industry continues to develop new applications for telehealth. However, barriers remain to the use of telehealth modalities, including issues related to reimbursement, licensure, workforce, and costs. Also, some areas of telehealth have developed a stronger evidence base than others. The Health Resources and Service Administration (HRSA) sponsored the IOM in holding a workshop in Washington, DC, on August 8-9 2012, to examine how the use of telehealth technology can fit into the U.S. health care system. HRSA asked the IOM to focus on the potential for telehealth to serve geographically isolated individuals and extend the reach of scarce resources while also emphasizing the quality and value in the delivery of health care services. This workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, and consumer acceptance of telehealth. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary discusses the current evidence base for telehealth, including available data and gaps in data; discuss how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, social networking, and wearable devices, in conjunction with the push for electronic health records, is changing the delivery of health care in rural and urban environments. This report also summarizes actions that the U.S. Department of Health and Human Services (HHS) can undertake to further the use of telehealth to improve health care outcomes while controlling costs in the current health care environment.

“A provocative examination of our health care delivery for the poor. . . . Such an honest and candid account is essential.” —Alex Kotlowitz, national bestselling author of There Are No Children Here Mama Might Be Better Off Dead immerses readers in the lives of four generations of a poor, African-American family from North Lawndale, Chicago, who are beset with the devastating illnesses that are all too common in America’s inner-cities. Headed by Jackie Banes, who oversees the care of a diabetic grandmother, a husband on kidney dialysis, an ailing father, and three children, the Banes family contends with countless medical crises. From visits to emergency rooms and dialysis units, to trials with home care, to struggles for Medicaid eligibility, Laurie Kaye Abraham chronicles their access—or lack thereof—to medical care. Their story reveals an inadequate health care system that is further undermined by the effects of poverty. Mama Might Be Better Off Dead is an unsettling, profound look at the human face of health care in America. This new edition includes an incisive foreword by David Ansell, a physician who worked at Mt. Sinai Hospital, where much of the Banes family’s narrative unfolds. “Goes to the heart of today’s problem. Powerful . . . deeply searching.” —Washington Post “A powerful indictment of the big business of medicine.” —Los Angeles Times “Abraham . . . illuminates the problems with passion and skill.” —Kirkus Reviews “This personally observed, lucid chronicle and call for reform of our ailing health system covers all levels of responsibility in the medical establishment.” —Publishers Weekly “Clearly identifies in human and policy terms how [healthcare] programs have failed a population desperately in need of help.” —Library Journal