Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-26T09:09:39.091Z Has data issue: false hasContentIssue false

Health Reform and the Safety Net: Big Opportunities; Major Risks

Published online by Cambridge University Press:  01 January 2021

Extract

Millions of Americans are dependent on what is often called the “safety net.” These loosely-organized networks of health and social service providers serve the many Americans who are uninsured, dependent on public coverage, or for a variety of reasons unable to access other private systems of care. The Institute of Medicine (IOM) report, America’s Health Care Safety Net: Intact but Endangered, called attention to both the fragility and the resilience of this health care safety net. The IOM report underscored the critical importance of the safety net to the health and well-being of millions of individuals and called for efforts to strengthen it and improve the nation’s ability to monitor its viability. Given this central role, any health care reform efforts need to be fully informed by an understanding of what the safety net includes, how it is financed, and how it is responding to a series of challenges it now faces.

Type
Symposium
Copyright
Copyright © American Society of Law, Medicine and Ethics 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Lewin, M. and Altaian, S., eds., America’s Health Care Safety Net: Intact but Endangered (Washington, D.C.: National Academy Press, 2000).Google Scholar
In response to recommendations in the report concerning safety net monitoring, the Agency for Healthcare Research and Quality issued several data reports on key access and outcome indicators related to the safety net, at <http://www.ahrq.gov/data/safetynet> (last visited June 21, 2004).+(last+visited+June+21,+2004).>Google Scholar
Lewin, M. and Altman, S., eds., America’s Health Care Safety Net (Washington, D.C.: National Academy Press, 2000): at 51.Google Scholar
Guidelines for Medically Underserved Area and Population Designation, Bureau of Health Professions Website, at <http://bhpr.hrsa.gov/shortage/muaguide.htm> (last visited June 21, 2004).+(last+visited+June+21,+2004).>Google Scholar
Baily, B.E. et. al., Experts with Experience Community & Migrant Health Centers Highlighting a Decade of Service (1990–2000) (Washington, D.C.: U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, 2002); “What kinds of patients go to safety net hospitals?” Issue Brief (Washington, D.C.: National Association of Public Hospitals, 2003).Google Scholar
Lewin, M. and Altman, S., America’s Health Care Safety Net (Washington, D.C.: National Academy Press, 2000): at 21.Google Scholar
Sec. 330 of the Public Health Service Act, 42 USC Sec. 254b.Google Scholar
Rosenbaum, S. and Dievler, A., A Literature Review of the Community and Migrant Health Centers Programs (Washington, D.C.: The George Washington University Center for Health Services Research and Policy, 1992).Google Scholar
Uniform Data System (UDS), Department of Health and Human Services, Health Resources and Services Administration (2002); Approximately 97 federally-qualified health center “look-alikes” serve another 1 million patients. Like CHCs, look-alikes are located in medically underserved areas and are eligible for cost-based reimbursement under Medicaid and Medicare. However, look-alikes receive no federal funding. Rosenbaum, S. and Shin, P., “Health Centers as Safety Net Providers: An Overview and Assessment of Medicaid’s Role,” Issue Brief (Washington, D.C.: Kaiser Commission on Medicaid and the Uninsured, 2003).Google Scholar
Hawkins, D. and Proser, M., “A Nation’s Health at Risk,” Special Topics Issue Brief #5 Washington, D.C.: National Association of Community Health Centers, 2004).Google Scholar
See UDS, supra note 9.Google Scholar
Schauffler, H.H. and Wolin, J., “Community Health Clinics under Managed Competition: Navigating Uncharted Waters,” Journal of Health Politics, Policy and Law 21, no. 3 (1996): 461488.CrossRefGoogle Scholar
See UDS, supra note 9.Google Scholar
Starr, P. The Social Transformation of American Medicine (New York, N.Y.: Basic Books, Inc., 1949).Google Scholar
Section 1867(a) of the Social Security Act.Google Scholar
National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey, 1992–2000.Google Scholar
Cunningham, P. J. and May, J.H., “Insured Americans Drive Surge in Emergency Department Visits,” Issue Brief no. 70 Washington, D.C.: Center for Studying Health System Change, 2003).Google Scholar
Mills, R.J. and Bhandari, S., Health Insurance Coverage in America: 2002 (Washington, D.C.: U.S. Census Bureau, 2003).Google Scholar
“What is a Safety Net Hospital?” Issue Brief Washington, D.C.: National Association of Public Hospitals and Health Systems, 2001).Google Scholar
Gage, L.S., “The Future of Safety Net Hospitals,” in Altman, S., Reinhardt, U.E., and Shields, A.E., eds., The Future U.S. Healthcare System: Who will Care for the Poor and Uninsured (Chicago, IL: Health Administration Press, 1998).Google Scholar
See UDS, supra note 9.Google Scholar
Singer, I., Davison, L., and Fagnani, L., America’s Safety Net Hospitals and Health Systems, 2001: Results of the 2001 Annual NAPH Member Survey (Washington, D.C.: National Association of Public Hospitals, 2003).Google Scholar
Tolbert, J., ed., Safety Net Financing: A Source Book for Healthcare Executives (Washington, D.C.: National Association of Public Hospitals and Health Systems, 2003).Google Scholar
The Commonwealth Fund, A Shared Responsibility: Academic Health Centers and the Provision of Care to the Poor and Uninsured (New York, N.Y.: The Commonwealth Fund, 2001).Google Scholar
Singer, , et. al., supra note 24.Google Scholar
Health Resources and Services Administration, “Budget and Appropriations” at <http://www.hrsa.gov/budget.htm> (last visited June 21, 2004).+(last+visited+June+21,+2004).>Google Scholar
The Health Care Safety Net Amendments of 2002, P.L. 107–251.Google Scholar
See UDS, supra note 9.Google Scholar
Felland, L.E., Kinner, J.K., and Hoadley, J.F., “The Health Care Safety Net: Money Matters but Savvy Leadership Counts,” Issue Brief no. 66 Washington, D.C.: Center for Studying Health System Change, 2003).Google Scholar
Singer, , et. al., supra note 24.Google Scholar
See UDS, supra note 9.Google Scholar
“How are Safety Net Hospitals Financed? Who Pays for Free Care?” Issue Brief Washington, D.C.: National Association of Public Hospitals and Health Systems, 2003).Google Scholar
See, for example: Shi, L., “The Relation Between Primary Care and Life Chances,” Journal of Health Care for the Poor and Underserved 2 (1992): 321–35; Shi, L., Starfield, B., Kennely, B., and Kavachu, I., “Income Inequality, Primary Care and Health Indicators,” Journal of Family Practice 48 (1999): 275–84.CrossRefGoogle Scholar
Smedley, B.D. Stith, A.Y., and Nelson, A.R., eds., Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Washington, D.C.: National Academy Press, 2002).Google Scholar
Hadley, J., Sicker and Poorer: The Consequences of Being Uninsured (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, May 2002).Google Scholar
Lave, J. and Keane, C., “The Impact of Lack of Health Insurance on Children,” Journal of Health and Social Policy 10, no. 2 (1998): 5773.CrossRefGoogle Scholar
In 2002, California and Texas reported the largest number of undocumented residents of 2.4 million and 1.1 million, respectively; Passel, J.S., Capps, R., and Fix, M., Undocumented Immigrants: Facts and Figures, (Washington, D.C.: Urban Institute, 2004).Google Scholar
Gaskin, D.J., “Are Urban Safety-Net Hospitals Losing Low-Risk Medicaid Maternity Patients?” Health Services Research 36, no. 1, (2001): Part I, 2551.Google Scholar
Marquis, M.S. and Long, S.H., “Trends in Managed Care and Managed Competition 1993–1997,” Health Affairs 18, no. 6 (1999): 7588; Maxwell, J., Temin, P., and Watts, C., “Corporate Health Care Purchasing among Fortune 500 Firms: The Nation’s Largest Employers Have Exacted All of the Savings They Can from Aggressive Purchasing and Switching Employees to Managed Care. What Will Their Next Move Be?” Health Affairs 20, no. 3 (2001): 181–188.CrossRefGoogle Scholar
Brewster, L.R., Rudell, L.S., and Lesser, C.S., “Emergency Room Diversions: A Symptom of Hospitals Under Stress” Issue Brief no. 38 Washington, D.C.: Center for Studying Health System Change, 2001). See also: Gordon, J.A., Billings, J., Asplin, B.R., and Rhodes, K.V., “Safety Net Research in Emergency Medicine: Proceedings of the Academic Emergency Medicine Consensus Conference on The Unraveling Safety Net,” Academic Emergency Medicine 8, no. 11 (2001): 1024–29.Google Scholar
See, for example, Fiscella, K., Frank, P., Gold, M.R., and Clancy, C.M., “Inequality in Quality: Addressing Socioeconomic, Racial and Ethnic Disparities in Health Care,” JAMA 283 (2000): 2579–84; Collins, K.S., Hughes, D.L., Doty, M.M.,et. al., Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans (New York, N.Y.: The Commonwealth Fund, 2002); Zuvekas, S.H., Weinick, R.M., and Cohen, J.W., “Racial and Ethnic Differences in Access to and Use of Health Care Services, 1977 to 1996,” Medical Care Research and Review 57, sup. 1 (2000): 36–54.CrossRefGoogle Scholar
Smedley, et. al., supra note 36.Google Scholar
Presentation by Patricia Gabow, MD, CEO and Medical Director, Denver Health Medical Center, to National Association of Public Hospitals Policy Fellows, March 6, 2002.Google Scholar
Presentation by Ben Chu, MD, MPH, President of the New York City Health and Hospitals Corporation, at the National Association of Public Hospitals and Health Systems Annual Meeting, A Vision for the Safety Net. June 20, 2002.Google Scholar
Politzer, R.M., Yoon, J.S., Hughes, R.G., and Gaston, M.H., “Inequality in America: The Contribution of Health Centers in Reducing and Eliminating Disparities in Access to Care,” Medical Care Research and Review 58, no. 2 (2001): 234–48.CrossRefGoogle Scholar
The Uniform Data System (UDS) is an annually released dataset on Bureau of Primary Health Care grantee health centers that includes patient demographics, financing, diagnoses, utilization, staffing, and services.Google Scholar
Rosenbaum, S., Shin, P., Roby, D., and Park, R., Health Centers: A National Profile (Washington, D.C.: The George Washington University Center for Health Services Research and Policy, 2001).Google Scholar
Lewin, M.E. and Altman, S., eds., America’s Health Care Safety Net: Intact but Endangered (Washington, D.C.: National Academy Press, 2000): at viii.Google Scholar
Morris, K., “Detroit Health Care in Critical Condition,” Detroit Free Press, October 1, 2003.Google Scholar
Lewin, M. and Altman, S., eds., Americas Health Care Safety Net (Washington, D.C.: National Academy Press, 2000): at 138.Google Scholar
Strengthening the Safety Net in Detroit and Wayne County: Report of the Detroit Health Care Stabilization Workgroup (Detroit, MI: Detroit Health Care Stabilization Workgroup, 2003) available at <http://www.michigan.gov/documents/ReportofDetroitHealthCareStabilizationWork-group_1_70764_7.pdf>..>Google Scholar
HHC Ambulatory Care Evolution 1, no. 1 (New York, N.Y.: Primary Care Development Corporation).Google Scholar
Bodenheimer, T., Wagner, E.H., and Grumbach, K., “Improving Primary Care for Patients With Chronic Illness” Journal of the American Medical Association 288 (2002): 1775–79.CrossRefGoogle Scholar
Lambert, B. and Healy, P., “At 2 Hospitals, Fiscal Troubles in the Glare of Public View,” New York Times, January 18, 2004.Google Scholar
Needleman, J., Chollet, D.J., and Lampere, J., “Hospital Conversion Trends,” Health Affairs 16 (1997): 187195.CrossRefGoogle Scholar
Bovbjerg, R. R., Marsteller, J.A., and Ullman, F. C., Health Care for the Poor and Uninsured After a Public Hospital Closure or Conversion (Washington, D.C.: The Urban Institute, 2000).Google Scholar
Wysocki, B., “At One Hospital, A Stark Solution for Allocating Care,” Wall Street Journal (September 23, 2003).Google Scholar
Andrulis, D.P., “The Public Sector in Health Care: Evolution or Dissolution?” Health Affairs 16 (1997): 131140.CrossRefGoogle Scholar
Piotrowski, J., “How Secure is the Safety Net? Public Hospitals Learn to Survive in an Increasingly Tight Market by Closing, Building, Replacing, and Sometimes Converting,” Modern Healthcare 32, no. 8 (2002): 34–7.Google Scholar