Public hospitals on the brink: their problems and their options.

This article defines the differences among public community hospitals, and examines the problems faced by those that serve primarily the poor. The article analyzes the impacts of (1) the tradition of local fiscal responsibility, (2) third-party funding arrangements, (3) public hospitals' bases of political support, and (4) problems in governance and administration. Three broad policy options for public hospitals are considered in the light of these impacts.