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The Inverse Care Law: Implications for Healthcare of Vulnerable Populations

Fiscella, Kevin MD, MPH; Shin, Peter PhD, MPH

Journal of Ambulatory Care Management: October-December 2005 - Volume 28 - Issue 4 - p 304–312

Past and present, those with the greatest healthcare needs often receive the least adequate healthcare. This phenomenon, termed the “inverse care law,” has implications for healthcare and outcomes for vulnerable populations including low-income persons, racial and ethnic minorities, and the uninsured among others. This article reviews disparities in health status and access to healthcare for vulnerable populations. It illustrates how concentration of risk factors within individuals, families, and communities worsens the paradox between healthcare need and access and highlights the models of healthcare delivery needed to adequately meet the needs of vulnerable populations.

Departments of Family Medicine and Community Preventive Medicine, University of Rochester School of Medicine & Dentistry, Rochester, New York (Dr Fiscella); and the Department of Health Policy, The George Washington University School of Public Health and Health Services, Washington, DC (Dr Shin).

Corresponding author: Kevin Fiscella, MD, MPH, 1381 South Ave, Rochester, NY 14620 (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.