Trends: An update on safety-net hospitals: Coping with the late 1990s and early 2000s

Department of Health Administration, Virginia Commonwealth University, in Richmond, USA.
Health Affairs (Impact Factor: 4.32). 07/2005; 24(4):1047-56. DOI: 10.1377/hlthaff.24.4.1047
Source: PubMed

ABSTRACT Recent forces have created new financial stress for hospitals but also some relief. This paper explores hospitals' changing involvement in the safety net between 1996 and 2002. We replicate approaches used in a study of 1990-1997 and thus provide a needed update on the U.S. hospital safety net. Overall, some groups of safety-net hospitals increased uncompensated care, but others did not. Non-safety-net hospitals trimmed certain services commonly used by the indigent; this may point to future reductions in access. We examine the implications of these findings for the future of the safety net.

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Available from: Richard C Lindrooth, Aug 04, 2015
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    • "Medicaid (publicly-funded program for the care of the very poor) sharply reduced the rate of growth in payments [30]; and 3) local government commitments dwindled. At the same time, public hospital managers faced greater constraints to adapt to these forces because of the special circumstances of public ownership, such as strong labor unions, political appointees who do not necessarily value strong management, and a view that the hospital is an important place of employment [2] [31]. "
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    ABSTRACT: Many countries with universal health systems have relied primarily on publicly-owned hospitals to provide acute care services to covered populations; however, many policymakers have experimented with expansion of the private sector for what they hope will yield more cost-effective care. The study provides new insight into the effects of hospital privatization in three American states (California, Florida, and Massachusetts) in the period 1994 to 2003, focusing on three aspects: 1) profitability; 2) productivity and efficiency; and 3) benefits to the community (particularly, scope of services offered, price level, and impact on charity care). For each variable analyzed, we compared the 3-year mean values pre- and postconversion. Pre- and postconversion changes in hospitals' performance were then compared with a nonequivalent comparison group of American public hospitals. The results of our study indicate that following privatization, hospitals increased operating margins, reduced their length of stay, and enjoyed higher occupancy, but at some possible cost to access to care for their communities in terms of higher price markups and loss of beneficial but unprofitable services.
    Value in Health 01/2013; 16(1 Suppl):S24-33. DOI:10.1016/j.jval.2012.10.003
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    • "This study provides important insights on hospital decision-making in relation to service capacity, focusing on services for which reimbursements fall short of associated costs. Earlier safety net institutions (mainly public or NFP hospitals) studies found that these hospitals did not eliminate certain services altogether when payment pressures were present (Bazzoli et al. 2005; Zuckerman et al. 2001). However, we found that NFP hospitals are likely to marginally adjust their volume of unprofitable services depending on their financial circumstances . "
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    ABSTRACT: Increases in hospital financial pressure resulting from public and private payment policy may substantially reduce a hospital's ability to provide certain services that are not well compensated or are frequently used by the uninsured. The objective of this study is to examine the impact of hospital financial condition on the provision of these unprofitable services for the insured and uninsured. Economic theory provides the conceptual underpinnings for the analysis, and a longitudinal empirical analysis is conducted for an eight-year study period. The results indicate that not-for-profit hospitals with strong financial performance provide more unprofitable services for the insured and uninsured than do not-for-profit hospitals with weaker condition. For-profit hospital provision of these services is not influenced by their financial condition and instead may reflect actions to meet community expectations or to offer a sufficiently broad service array to maintain the business of insured patients.
    Atlantic Economic Journal 09/2009; 37(3):259-277. DOI:10.1007/s11293-009-9183-9
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    • "It is not clear, however, whether hospitals can meet the growing demand for uncompensated care under current financing mechanisms. Recent research has documented deteriorating financial condition among safety net hospitals providing large volumes of care to the uninsured (Bazzoli et al., 2005). In addition, there are signs that hospitals in poor and lowincome areas are falling behind hospitals in wealthier areas in terms of access to new technologies and ability to upgrade their facilities (Center for Studying Health system Change, 2005). "
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