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Presentation 377 THE POLITICAL AGENDA OF HEALTH CARE FOR AFRICAN AMERICANS THOMAS J. BROOKS III, MD Family Health Services Abstract: Health care reform presents both challenges and opportunities for African Americans. On the one hand, reform could result in the closure of black medical institutions and fewer black physicians. On the other hand, reform gives African Americans an opportunity to bargain for available resources to gain equality in health care services. To this end, the Volunteer State Medical Association has been involved in state health care reform. Its goals are to resolve the current financial crisis at black medical institutions; to assist in the survival and development of local black managed care organizations·, to assure that all licensed black physidans have continued access to patients; and to develop black-owned healthrelated businesses. The association has formed the Tennessee Coalition for Quality Health Care, a group of African American politicians, physicians, educators, and health care administrators who can negotiate with state and federal officials in the issue of health care reform. Key words: Health care reform, African Americans, managed care Health care reform presents a number of chaUenges as weU as opportunities for African Americans. On the one hand, reform could destroy the "black health care system" as we know it. There are two health "systems" in this country: the black health care deUvery system and the white health care deUvery system. The two systems have dear distinguishing features. First of aU, very little sodalizing occurs between white and black physidans, and referral patterns reflect that. Black physidans refer patients to white specialists ; however, white physidans refer few patients to black specialists. Also, the patient profile of black and white physidans is different. Black practices have a significantly higher percentage of medicaid or TennCare* patients, Medicare, and poor patients. Because black physidans' practices contain more Medicaid, Tennessee's reorganized health care system for poor and indigent patients initiated in 1993. Journal of Health Care for the Poor and Underserved · Vol. 8, No. 3 · 1997 378 The PoUtical Agenda of Health Care poor, and disadvantaged patients, the compensation and average income of black physidans is less than that of their white counterparts. Most black practices are solo or smaU, single-spedalty group practices, and nearly aU black physidans are currently practicing in inner dty, urban, or disadvantaged communities. Therefore, black physicians and patients have a greater stake in the outcome of health care reform. On the other hand, health care reform gives African Americans an opportunity , for the first time, to bargain for available resources and thereby place themsdves in a position of equaUty in terms of health care. Health care reform provides the African American community with the opportunity to solve not only health-related problems that affect the community but also economic problems. This is not limited to the notion of giving black physicians their fair share of health care doUars but of black patients receiving the kind of medical services they need, such as transportation to and from health care f adUties and the availability of home health care on a daüy basis, among other necessities. Health care reform means the restructuring of the entire economic foundation of the African American community. The Volunteer State Medical Assodation has been involved in the issue of state health care reform from its inception. We met with the former governor* when he was about to devdop TennCare. Our major goal in meeting with the governor was to ensure that health care doUars continued to flow into the African American community through black institutions, management firms, and physidans. In our proposal to the governor, we Usted our four objectives, which are as foUows: 1. To resolve the current finandal crisis at Meharry Medical CoUege and other black health care institutions across the country; 2. To assist in the survival, growth, and development of local black health care management organizations; 3. To assure that aU Ucensed black physicians have continued access to patients; 4. To assist and develop black-owned health-related businesses, such as medical technology companies. At that time, we also petitioned the Health Care Financing Administration (HCFA) requesting that they not withdraw the requirement that states seek federal approval before...

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