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"Managed Care and Beyond: Fostering Health in Our Community ".__ <br />those organizations because of the increased competition for patients with a <br />payment source. The competitors do not provide access to the uninsured <br />and underinsured. He finds that a market -share approach to health care is <br />not always in the best interest of patients and families. Florence Soltys <br />presented the fact that there are more people over 65 than in school systems <br />in Orange County. She brought up the need to teach interdisciplinary care <br />that includes the home, community, and institutional resources. Audreye <br />Johnson elaborated on the plight of children and families. Social workers <br />are faced with the results of welfare reform, managed care, and an <br />undereducated populace. Women often find themselves as caregivers on <br />both ends of the spectrum, caring for children, parents, and sometimes <br />husbands. Ms. Johnson also recommended an expanded concept of family <br />that includes fictive kin or all people working and caring for each other. <br />The panel discussion was moderated by Rosemary Summers, Orange County <br />Health Director., and ranged over a wide array of topics. Katherine Leith <br />with the Department on Aging described situations where the elderly end up <br />in hospital situations for want of prescription coverage. Others expressed <br />concern about the changes Triangle Hospice is going through <br />organizationally in its affiliation with Duke. Another topic was the potential <br />shortfall in the North Carolina Mental Health Budget. Allan Hamrick and <br />Tom Maynard both favored a more long- sighted approach to developing a <br />mental health infrastructure that would accept temporary budget increases in <br />favor of long -term savings. John Link, Orange County Manager, spoke <br />from his own experience about the difficulties in finding appropriate in -home <br />care for seniors. Teresa Smith with Day Care Services talked about the <br />difficulties children with Medicare are having finding dental care. An <br />increase in Medicare payment rates might not be effective because there is <br />already a shortage of dental providers. <br />The forum's morning session closed as the forum participants separated into <br />five working lunch groups after the panel discussion with different <br />concentrations?. Each group was charged to resolve the following three <br />questions: <br />♦ What are the issues? <br />♦ What should be done? <br />♦ Who will do this? <br />The five groups' findings are summarized below. <br />14 <br />� <br />