Caught in the competitive crossfire: safety-net providers balance margin and mission in a profit-driven health care market

Health Affairs

Volumn 27, Issue 5, 2008, Pages

  Cunningham, Peter J ^c   Bazzoli, Gloria J ^a   Katz, Aaron ^b  

^a VIRGINIA COMMONWEALTH UNIVERSITY   (United States)

^b UNIVERSITY OF WASHINGTON   (United States)

^c NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HEALTH CARE COST; HEALTH CARE FACILITY; HEALTH CARE POLICY; HEALTH CARE SYSTEM; HEALTH INSURANCE; HEALTH SERVICE; MEDICAID; PROFIT;

ECONOMIC COMPETITION; ECONOMICS, HOSPITAL; HEALTH FACILITIES; HOSPITAL DESIGN AND CONSTRUCTION; HOSPITALS, PRIVATE; HUMANS; PUBLIC POLICY; UNCOMPENSATED CARE; UNITED STATES;

EID: 54349091782     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.27.5.w374     Document Type: Article

References (17)

1. M.E. Lewin and S. Altman, eds., America's Health Care Safety Net: Intact but Endangered (Washington: National Academies Press, 2000).
2. L.E. Felland et al., "The Resilience of the Health Care Safety Net, 1996-2001," Health Services Research 38, no. 1, Part 2 (2003): 489-502.
3. R.A. Berenson, T. Bodenheimer, and H. Pham, "Specialty-Service Lines: Salvos in the New Medical Arms Race," Health Affairs 25 (2006): w337-w343 (published online 25 July 2006; 10.1377/ hlthaff.25.w337);
4. and K.J. Devers, L.R. Brewster, and L.P. Casalino, "Changes in Hospital Competitive Strategy: A New Medical Arms Race?" Health Services Research 38, no. 1, Part 2 (2003): 447-469.
5. Ibid.
6. L.P. Casalino, H. Pham, and G. Bazzoli, "Growth of Single-Specialty Medical Groups," Health Affairs 23, no. 2 (2004): 82-90; and Berenson et al., "Specialty-Service Lines."
7. The four categories of construction activity reported here are based on those identified by G.J. Bazzoli, A. Gerland, and J. May, "Construction Activity in U.S. Hospitals," Health Affairs 25, no. 3 (2006): 783-791, in their analysis of 2005 Community Tracking Study (CTS) data.
8. Trends in hospital uncompensated care costs were obtained from American Hospital Association, "Uncompensated Hospital Care Cost Fact Sheet," October 2006, http://www.aha.org/aha/ content/2006/pdf/uncompensatedcarefs2006. pdf (accessed 1 August 2008). Trends in the number of uninsured Americans were obtained from P. Fronstin, "Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2007 Current Population Survey," EBRI Issue Brief no. 310 (Washington: Employee Benefit Research Institute, 2007).
9. P.J. Cunningham and J.H. May, "A Growing Hole in the Safety Net: Physician Charity Care Declines Again," Tracking Report no. 13 (Washington: Center for Studying Health System Change, March 2006).
10. O. Zaman, E. Lukens, and L. Cummings, "America's Public Hospitals and Health Systems, 2004: Results of the Annual NAPH Hospital Characteristics Survey" (Washington: National Association of Public Hospitals and Health Systems, 2006); and I. Singer, L. Davison, and L. Fagnani, "America's Safety Net Hospitals and Health Systems, 2001: Results of the 2001 Annual NAPH Member Survey" (Washington: NAPH, 2003).
11. Medicare Payment Advisory Commission, "Acute Inpatient Services," sec. 7 in A Data Book: Healthcare Spending and the Medicare Program, http://www.medpac.gov/chapters/Jun07DataBookSec7 .pdf (accessed 15 July 2008).
12. In Lansing, respondents reported that the tertiary facility at the University of Michigan in Ann Arbor was restricting access to care for uninsured people from outside the local area, which does affect Lansing.
13. Estimates for 2001 are from Singer et al., "America's Safety Net Hospitals and Health Systems, 2001"; estimates for 2005 are unpublished estimates provided by NAPH.
14. Felland et al., "The Resilience of the Health Care Safety Net."
15. "2007 Relative Scope and Review Thresholds: CON Regulated Services by State," as compiled by Thomas R. Piper, director, Missouri Certificate-of-Need Program, http://www.chppd.org/ con_issues.html (accessed 30May 2008).
16. J. Hearne, "Medicaid Disproportionate Share Payments," CRS Report for Congress (Washington: Congressional Research Service, updated 10 January 2005).
17. Singer et al., "America's Safety Net Hospitals and Health Systems, 2001"; and unpublished estimates from NAPH for 2005.