ABSTRACT
This chapter examines the realities that determined the availability of neighborhood health care services in New York, and then advance a limited number of modest suggestions that might help to improve service delivery to groups most in need of more and better care. The aim of the project was to strengthen local community health centers so that low-income residents could obtain more and better health care than by crowding the emergency rooms and clinics of municipal and voluntary hospitals. There are about thirty-five to forty community health centers operating in New York City, but no more than ten functions in a way that they and their patients consider fully satisfactory. The combination of weakened health clinics, a stressed municipal hospital system, and many voluntary hospitals that are racing toward bankruptcy because of the volume of unreimbursed ambulatory services that they provide has serious consequences for the care received by the poor and the needy.