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West J Med. 1985 May; 142(5): 708–709.
PMCID: PMC1306167

The Return of Two-Class Medicine—III Effects of Medi-Cal Reform

Howard Waitzkin, MD, PhD, Professor of Medicine and Social Sciences, Chief


California's drastic Medi-Cal reforms have created great difficulties in health care for the poor. Patients' clinical problems seldom are apparent in descriptions of changes in public insurance programs. Rapidly escalating costs of Medi-Cal led to irresistible pressures for reform, especially from the business community. The new Medi-Cal regulations provide for prospective contracts with hospitals for inpatient services, the transfer of “Medically Indigent Adults” to the responsibility of county governments and various other straightforward funding cutbacks. Confusion, disruption of services and adverse health outcomes have accompanied the Medi-Cal reforms.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Melia EP, Aucoin LM, Duhl LJ, Kurokawa PS. Competition in the health-care marketplace. A beginning in California. N Engl J Med. 1983 Mar 31;308(13):788–792. [PubMed]
  • Kinzer DM. Massachusetts and California--two kinds of hospital cost control. N Engl J Med. 1983 Apr 7;308(14):838–841. [PubMed]
  • Iglehart JK. Health Policy Report. Medicaid turns to prepaid managed care. N Engl J Med. 1983 Apr 21;308(16):976–980. [PubMed]
  • Lurie N, Ward NB, Shapiro MF, Brook RH. Termination from Medi-Cal--does it affect health? N Engl J Med. 1984 Aug 16;311(7):480–484. [PubMed]
  • Waitzkin H. Two-class medicine returns to the United States: impact of Medi-Cal reform. Lancet. 1984 Nov 17;2(8412):1144–1146. [PubMed]

Articles from The Western Journal of Medicine are provided here courtesy of BMJ Publishing Group