title: Urologists on a tightrope--do we have a net?
abstract: OBJECTIVE
  The purpose of this review is to analyze the current health care environment and its impact on urological practice.
  
  
  METHODS
  The medical and lay literature as it pertains to the socioeconomics of health care was reviewed.
  
  
  RESULTS
  Analysis of the political and economic factors that influence the delivery of health care today reveals alarming realities. More than 40 million Americans remain uninsured, and with a retrenched economy that number is likely to increase. Neither government nor the private sector has been either willing or able to address the health care problem in a coherent or comprehensive way. As the population ages, the Medicare and Medicaid programs will become further stressed. Employers are increasingly unwilling to finance the health care expenses of their employees. Academic medical centers are facing unique exigencies that, if left uncorrected, will jeopardize the future training of physicians.
  
  
  CONCLUSIONS
  In the current environment of a depressed economy, further proposed tax cuts and increased military spending it appears inevitable that the economic restraints on medical care will increase substantially in the foreseeable future.
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Loughlin
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration* / Q000639:trends; D016527:Drug Costs; D005544:Forecasting; D006264:Health Benefit Plans, Employee / Q000191:economics; D017048:Health Care Costs / Q000639:trends; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health / Q000191:economics; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D008329:Managed Care Programs; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D009726:Nurses / Q000600:supply & distribution; D014481:United States; D014572:Urology / Q000191:economics / Q000639:trends