This issue of the journal marks the beginning of a new journal effort to debate the critical links between decreasing the uninsured, providing financial incentives to improve quality, and the critical role of ambulatory care management to the success of these two efforts. The organizational authors of this article are Health Care For All, the principal community-based organization behind the Massachusetts health reform legislation passed last year, and Community Catalyst, an organization that works in partnership with consumer and community groups around the country to promote healthcare justice.* Other than the important activity pertaining to the renewal of the State Children's Health Insurance Program (SCHIP), there is little activity on universal coverage occurring at a national level. All the action on increasing access to health insurance coverage is occurring at a state level. California is the latest state to have a proposal in play. In many ways, the California proposal is modeled on the Massachusetts legislation.

As taxpayers, if we are ever to have universal healthcare coverage we should be vitally interested in efforts to stabilize healthcare costs in this country. Otherwise, as taxpayers, we are simply throwing good money away at the many organizational interests who are doing "just fine thank you" with the present healthcare system. At the same time, we know from the research literature that merely shifting costs onto consumers via health/medical savings accounts neither improves quality nor stabilizes costs. Health Care for All/Community Catalyst article forcefully, and in a practical manner, addresses this challenge of improving quality and stabilizing costs (Tamblyn et al., 2001). We are fortunate to have a number of commentaries on this article and I look forward to publishing many rebuttals and amplifications on the specific proposals. I am particularly interested in articles that deal directly with any of the proposals.

There are many efforts to improve coordination of care for individuals with chronic illnesses. The next several articles discuss key areas under active research. Socioeconomic disparities represent a significant challenge in attempting to improve medical control of chronic diseases. Saxena and colleagues provide an excellent summary of trials to improve diabetes care for minorities. Gross et al address a different issue-the relationship between physician organizational engagement with accepted medical practice and adherence with diabetes guidelines. Johnson and colleagues provide a summary of research results on one type of disease management intervention. It is important to publish the latter type of article as disease management efforts are very widespread in the United States and yet have not demonstrated much efficacy. This article highlights the many challenges in documenting efficacy. In particular, there are issues of case mix that are difficult to address and are not completely resolved even in this article. However, publishing articles by researchers such as Johnson serves to stimulate debate.

The last several articles in this issue serve to highlight the interest of the journal. Frank Zilm writes a case study on design issues pertaining to ambulatory care, this time focused on the emergency department. Seligman and coauthors provide us with new information on issues pertaining to disparities in care for ethnic groups served under fee for service versus managed care. Physicians for Human Rights contributes the regular human rights column, this time on raising awareness among US policy makers about global HIV pandemic related to injection drug use Lastly, Mark Holt provides us with a timely update with healthcare changes in the home state of our president.

Norbert Goldfield, MD, Editor

REFERENCE