The Status of Local Health Care Safety Nets

Health Affairs

Volumn 16, Issue 4, 1997, Pages 7-23

  Baxter, Raymond J ^a   Mechanic, Robert E ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COST CONTROL; ECONOMICS; FORECASTING; HEALTH CARE DELIVERY; HEALTH CARE ORGANIZATION; HEALTH INSURANCE; HUMAN; MEDICAID; PATIENT; SOCIAL CARE; SOCIAL WELFARE; SOCIOECONOMICS; STATISTICS; UNITED STATES;

COST CONTROL; FORECASTING; HEALTH CARE RATIONING; HEALTH SERVICES ACCESSIBILITY; HUMANS; MANAGED CARE PROGRAMS; MEDICAID; MEDICAL INDIGENCY; MEDICALLY UNINSURED; PUBLIC ASSISTANCE; SOCIAL WELFARE; UNITED STATES;

EID: 0005700351     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.16.4.7     Document Type: Article

References (18)

1. D.J. Lipson and N. Naierman, "Effects of Health System Changes on Safety-Net Providers," Health Affairs (Summer 1996): 33-48.
2. Our work was supported variously by The Robert Wood Johnson Foundation; The Center for Studying Health System Change; the Community Initiatives of the United Auto Workers, General Motors, and Chrysler; Hennepin County, Minnesota; a coalition of county and private providers in San Mateo, California; and the Syracuse Hospital Executive Council. The communities included Syracuse; Boston; New York City; Newark; Cleveland; Philadelphia; Greenville (South Carolina); Miami; Minneapolis; Lansing and Flint (Michigan); Kokomo, Indianapolis, and Anderson (Indiana); Memphis; Little Rock; Dallas; Seattle; San Mateo, Los Angeles, and Orange County (California); and Phoenix.
3. On average, the top 10 percent of hospitals in these ten cities account for 53 percent of the reported cost of bad debt and charity care. They also are larger than average, accounting for 26 percent of total hospital expenses. The concentration bad debt and charity care as a percentage of expenses varies differently across these ten cities.
4. A.L. Kellerman, "Nonurgent Emergency Department Visits: Meeting an Unmet Need," Journal of the American Medical Association 271, no 24 (1994): 1953-1956; and D.W. Baker, C.D. Stevens, and R.H. Brook, "Regular Source of Ambulatory Care and Medical Care Utilization by Patients Presenting to a Public Hospital Emergency Department," Journal of the American Medical Association 271, no. 24 (1994): 1909-1912.
5. A.L. Kellerman, "Nonurgent Emergency Department Visits: Meeting an Unmet Need," Journal of the American Medical Association 271, no 24 (1994): 1953-1956; and D.W. Baker, C.D. Stevens, and R.H. Brook, "Regular Source of Ambulatory Care and Medical Care Utilization by Patients Presenting to a Public Hospital Emergency Department," Journal of the American Medical Association 271, no. 24 (1994): 1909-1912.
6. National Association of Public Hospitals and Health Systems, "Characteristics of NAPH Member Hospitals" (Washington NAPH, December 1996).
7. D. Hawkins and S. Rosenbaum, "The Challenges Facing Health Centers in a Changing Health Care System," in The Future U.S. Health Care System: Who Will Pay? (Chicago: Health Administration Press, forthcoming).
8. NAPH, "Characteristics of NAPH Member Hospitals."
9. Lipson and Naierman, "Effects of Health System Changes on Safety-Net Providers."
10. P. Jacobs, "A Bitter Competition for Medi-Cal Patients," Los Angeles Times, 1 November 1995, 19.
11. Ibid.
12. M. McCloy, "Hospital of Last Resort? Safety-Net Plans Pose Questions," The Arizona Republic, 8 December 1996, Al.
13. Lipson and Naierman, "Effects of Health System Changes on Safety-Net Providers."
14. Deloitte and Touche LLP, "Safety Net at Risk: The Future of the Massachusetts Uncompensated Care Pool" (September 1996).
15. Patricia A. Gabow, chief executive officer and medical director, Denver Health, presentation at The Robert Wood Johnson Foundation/Health Affairs/Alpha Center conference, "What Is Happening to the Safety Net?," 9 January 1997, Washington, D.C. See also, P.A. Gabow, "Denver Health: Initiatives for Survival," Health Affairs (July/August 1997): 24-26.
16. National Association of Public Hospitals and Health Systems, "Reforming the Medicaid Disproportionate Share Hospital Program" (Draft working paper, January 1997).
17. New Jersey Department of Health and Senior Services, "Commissioner Announces Plan for a Charity Care/Managed Care System," News Release, 12 December 1996.
18. Examples of this are the Health Professions Education Community Partnerships and Community-Based Public Health Initiatives of the W.K. Kellogg Foundation.