Paying the price: medical care, minorities, and the newly competitive health care system.

The newly competitive health care system reflects both an excess supply of health care providers and a greater sensitivity to price among those purchasing health services. These dual pressures are felt in public programs as well as in private markets. A competitive ethos is also changing popular expectations of the appropriate relation between health care institutions and their communities. These changes offer opportunities for enhanced access to health care for some black Americans, but portend dire restrictions on access for the least-advantaged blacks. They also threaten to reduce significantly the influence exerted by black communities over their local health care providers.