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: 4.97). 07/2005; 24(4):1047-56. DOI: 10.1377/hlthaff.24.4.1047
Source: PubMed


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
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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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    • "Empirical studies of hospitals with high safety net activities have produced no clear consensus as to their financial status. Both Zuckerman et al. (2001) and Bazzoli et al.(2005) for example, found that hospitals ranked in the highest 10th percentile in the provision of uncompensated care and/or of hospitals with correspondingly disproportionately high shares of uncompensated care performed more poorly compared to the profitability of other hospitals during 1990-2002 [16,17]. Other studies found that hospitals that served vulnerable populations were able to survive during 1990s by adopting strategies that decreased costs and maximized revenues in response to market and policy changes [7,18]. "
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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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