hospitals overall. The number of public hospitals in major suburbs declined 27% (134 to 98) from 1996 to 2002. Much research has proven the increase in uninsured and Medicaid enrollment entwined to unmet needs for disproportionate share subsidies to be associated with the challenges faced by public hospitals to maintain their financial viability as they compete with the private sector for paying patients. Since the creation of the Affordable Care Act (ACA) in 2010, 15 million of the 48 million previously uninsured receive Medicaid. It is projected that this number will grow to about 33 million by 2018. The provision of good quality ambulatory specialty care for these uninsured and Medicaid enrolled patients has particularly been a challenge for many urban public hospitals. This accounts for many factors ranging from a shortage of specialists who are more likely to practice in the more profitable sectors than in the safety-net, to the lack of clinical space. To overcome this challenge, some public hospitals have adopted disease prevention methods, the increase of specialty providers and clinics, deployment of nurse practitioners and physician assistants in specialty clinics, asynchronous electronic consultations, telehealth, the integration of Primary Care Providers (PCP) in the specialty clinics, and referral by PCP's to specialists. Asia China After the Cultural Revolution, public healthcare was mandatory and private hospitals became public, state run hospitals. Each person was taken care of by the community, both for his or her job and for his or her health. Medicine focused mainly on primary care and basic prevention. The reception structures corresponded to Western dispensaries or hospitals. Because of the welfare state, both hospitals and dispensaries were public. Patients did not pay for the care they receive. However, in hospitals there were differences in the quality of care between managers, their families, deserving workers and other patients. Epidemic prevention posts was set up in 1954 throughout the country and made it possible to eradicate many epidemics. Large-scale vaccination campaigns and the strengthening of medical care in impoverished rural areas made it possible to prevent many diseases. Life expectancy rose from 35 years in 1949 to 65.86 years in 1978. The 1979 reform of the health system reduced public funding for hospitals from 90% to 15%. Hospitals must be 85% self-financing. As a result, patients have to pay for their health care. Thus, many people can no longer afford to go to hospital for treatment. In