Viewpoint:

The lack of health insurance has significant deleterious effects on the health of individual patients and creates substantial financial pressure on health care institutions. Despite the historical role of academic medical centers (AMCs) and medical schools in caring for the uninsured, financial shortfalls have increased pressure on these institutions to restrict care of this population. Limiting care of the uninsured, however, conflicts with the ethical foundations of academic medicine and risks further harm to the health of this population. Instead of restricting care, the effects of uninsurance should be mitigated through the joint efforts of medical schools and AMCs by measuring clinical work using work Relative Value Units rather than collections; recognizing faculty who provide care for the uninsured in the promotions process; adjusting billing rates for clinical services according to patients' ability to pay; delivering one standard of care irrespective of insurance status; continuing to evaluate the impact of uninsurance and intervention strategies; providing leadership in measuring and improving the quality of care; ensuring that trainees and the public are familiar with the effects of a lack of health insurance; and assisting safety net providers by providing educational materials pertinent to their respective patient populations and more fully integrating these providers into the academic community. Although all physicians in the private and public sectors should share in the care of the uninsured, academic medicine must remain faithful to its historical role of providing care to the uninsured and should improve the health of the uninsured through a proactive strategy involving advocacy, clinical care, education, and research.