Community-based health care: contradictions and challenges.

Social contradictions, including uneven economic development and the private-public duality, make community-based provision of health care difficult. The unrestricted expansion of private medical centers has been criticized from several perspectives including inadequate coordination of services, high costs, and negative effects on urban housing and living conditions. Corporate and professional control over health policy, monopolization, and public subsidization foster expansion of private institutions. While private facilities enlarge, public health-care institutions deteriorate, close, or shift to private management. Many clients eligible for care at public hospitals do not receive adequate attention in the private sector. Despite their achievements, community clinics have problems that threaten their survival. The financial insecurity of community clinics is an inherent feature of the private-public duality that affects the entire health-care system. Community clinics and public hospitals offer a potential for broader organizing and empowerment.