Federal block grants and public health: a call for physician partnership and leadership. AMA Council on Scientific Affairs.

Current transitions in health care financing and delivery systems have significant implications for public hospitals, community clinics, and health agencies, which provide important outreach and preventive services and rely heavily on federal and state funds. Strong concerns are being raised about the consequences of abrupt and drastic changes in funding of community health institutions and the continuing deterioration of rural and urban public health infrastructures. The viability of public hospitals, clinics, and local health agencies is threatened as government officials consider proposals for defunding, restructuring, or eliminating these entities. In 1996, Congress, the Clinton administration, and state and local government officials considered federal grant proposals and reforms that had potentially far-reaching implications for medical and public health professionals, expressing strong interest in consolidating various specific and narrowly defined categorical grant programs into broader block grant programs. Although no legislation was enacted, deliberations about federal block grant proposals provided important opportunities for physicians and medical societies to support public health activities and guard against further funding reductions that could weaken community health programs and diminish existing levels of quality and access. Ultimately, such deliberations provided a stimulus for medical associations and physicians to strengthen or renew partnerships with public health agencies and officials and provide necessary leadership to ensure that public health and preventive medicine become more integral components of the nation's health system.