Center for Studying Health System Change

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Hot Issues

Health Care Safety Net

Ready or Not: Are Health Care Safety Net Systems Prepared for Reform?
June 2013

As part of the California Health Care Almanac project, the California HealthCare Foundation (CHCF) funded HSC to conduct interviews in six California communities in 2011-12 to assess how the organization, financing and delivery of health care are changing, including preparations for health reform.

CHCF Regional Market Issue Brief

Local Public Hospitals: Changing with the Times
Nov. 29, 2012

In recent years, local public hospitals have stayed afloat financially without abandoning their mission to care for low-income people by expanding access to primary care, attracting privately insured patients and paying closer attention to collection of patient revenues, among other strategies, according to a qualitative study by the Center for Studying Health System Change (HSC).

HSC Research Brief No. 25
News Release

Health Care Safety Net Coordination Grows in Some Communities
Aug. 6, 2012

Safety net clinics, hospitals and other providers that care for uninsured and low-income people increasingly are seeking ways to coordinate services to increase access, improve quality and reduce costs, according to a study by HSC published in the August edition of Health Affairs.

Journal Article -- (Free Access.)
Media Advisory

Majority of Medicaid ED Visits for Urgent or More Serious Symptoms
July 2012

Contrary to conventional wisdom that Medicaid patients often use hospital emergency departments for routine care, the majority of ED visits by nonelderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems, according to a national study by the Center for Studying Health System Change (HSC).

Research Brief No. 23
News Release

A Long and Winding Road: Federally Qualified Health Centers, Community Variation and Prospects Under Reform
November 2011

Tracing their roots to the civil rights movement and the 1960s’ War on Poverty, federally qualified health centers (FQHCs) have grown from fringe providers to mainstays of many local health care system safety nets, according to a study by the Center for Studying Health System Change (HSC).

Research Brief No. 21
News Release

Economic Downturn Strains Miami Health Care System
September 2011

Despite the economic downturn’s severe fallout on Miami’s tourism, real estate and construction sectors, some hospitals are expanding beyond their traditional geographic markets to compete for privately insured patients, according to a Community Report HSC.

Miami Community Report
News Release

Improving Health Care Access for Low-Income People: Lessons from Ascension Health's Community Collaboratives
July 2011

Communities that formally build collaborative health care safety nets can offer lessons for national health reform by offering roadmaps on how to improve access, reduce the use of unnecessary emergency and inpatient care, and improve people’s health, according to a qualitative study by HSC published in the July edition of Health Affairs.

Journal Article Abstract -- Free access until July 2012
News Release

Early Impacts of the Recession on Health Care Safety Net Providers
Jan. 27, 2010

While the recession increased demands on the health care safety net as Americans lost jobs and health insurance, the impact on safety net providers has been mixed and less severe—at least initially—than expected in some cases, according to a new HSC study of five communities—Cleveland; Greenville, S.C.; northern New Jersey; Phoenix; and Seattle.

Research Brief No. 15
News Release

Suburban Poverty and the Health Care Safety Net
July 2009

As suburban poverty increases, the availability of health care services for low-income and uninsured people in the suburbs has not kept pace, according to a new study by HSC of five communities—Boston, Cleveland, Indianapolis, Miami and Seattle..

Research Brief No. 13
News Release

Do Reimbursement Delays Discourage Medicaid Participation by Physicians?
November 18, 2008

Policymakers have focused primarily on increasing Medicaid reimbursement rates to increase physicians’ participation in Medicaid, although physicians often complain of payment delays and other administrative burdens associated with Medicaid. Linking state-level data on average reimbursement times to the 2004-05 Community Tracking Study Physician Survey, this study examines how Medicaid reimbursement time affects physicians’ willingness to accept Medicaid patients. Delays in reimbursement can offset the effects of high Medicaid fees, thereby lowering participation to levels that are closer to those in states with relatively low rates. Increasing these rates may be insufficient to increase physicians’ participation unless accompanied by reductions in administrative burden.

Journal Article Abstract
News Release

Caught in the Competitive Crossfire: Safety-Net Providers Balance Margin and Mission in a Profit-Driven Health Care Market
Aug. 12, 2008

As private physicians and hospitals shed unprofitable patients and services, safety net providers are balancing their mission to serve the needy with steps to attract higher-paying patients to shore up their margins. To maintain financial viability, some safety-net providers—the patchwork of hospitals, community health centers (CHCs) and free clinics that either have an explicit mission to serve low-income and uninsured patients or are widely recognized as playing that role in their communities—are trying to limit exposure to uncompensated care and adopting such private-sector strategies as renovating and expanding facilities and focusing on lucrative specialty care to attract higher-paying privately insured and Medicare patients.

Journal Article
News Release

Community Efforts to Expand Dental Services for Low-Income People
July 2008

Recognizing the difficulties low-income people face in getting dental care, many communities are attempting to provide more dental services to vulnerable residents, according to a study released today by the Center for Studying Health System Change (HSC). Lack of dental care is the key contributor to oral health problems, with low-income people and some racial and ethnic minorities receiving fewer dental services than higher-income people and whites, according to the Agency for Healthcare Research and Quality. Poor oral health may contribute to other health problems, including heart and lung disease, stroke, and premature births. Abscessed teeth can cause severe infections and even death.

Issue Brief No. 122
News Release

Safety Net Hospital Emergency Departments: Creating Safety Valves for Non-Urgent Care
May 2008

Faced with more patients seeking care for non-emergencies, safety net hospital emergency departments are working to redirect patients to outpatient clinics, community health centers and private physicians, with varied results. Low-income, uninsured and Medicaid patients often turn to emergency departments (EDs) for care because they lack timely access to care in other settings, according to the study. The growing reluctance of physicians and dentists to serve Medicaid and uninsured patients, along with shortages of primary care physicians and certain specialists, such as psychiatrists, in some communities make obtaining clinic or physician appointments increasingly difficult.

Issue Brief No. 120
News Release

Relief, Restoration and Reform: Economic Upturn Yields Modest and Uneven Health Returns
January 2008

The sensitivity of state budgets to economic cycles contributes to instability in public health insurance eligibility, benefits and provider payments, as well as support for safety net hospitals and community health centers.

Issue Brief No. 117
News Release

Community Health Centers Tackle Rising Demands and Expectations
December 2007

Despite significant federal funding increases, community health centers (CHCs)—the backbone of the nation's safety net—are struggling to meet rising demand for care, particularly for specialty medical, dental and mental health services. Since 2000, federal funding for federally qualified community health centers—key providers of preventive and primary care for underserved people—has doubled to nearly $2 billion annually in 2006, according to the Health Resources and Services Administration (HRSA). More than 16 million patients—primarily racial or ethnic minorities, low income, uninsured or covered by Medicaid—received care at more than 1,100 federally qualified and look-alike health centers in 2006, up from just more than 10 million patients in 2001, according to HRSA.

Issue Brief No.116
News Release

A Widening Rift in Access and Quality: Growing Evidence of Economic Disparities
December 2005

As health care gobbles up an ever-larger share of the U.S. economy, the inability or unwillingness to ensure equal access to high-quality health care is fueling a widening rift between rich and poor Americans.

Journal Article
News Release

Click here for more research on the health care safety net.


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