Most Uninsured People Unaware of Health Care Safety Net Providers

Originally published by the Center for Studying Health System Change (HSC) as Issue Brief No. 90, November 2004.

Uninsured Americans and Awareness of Safety Net Providers

Less than half of uninsured Americans either regularly used or were aware of a safety net provider in their community, according to a national study by the Center for Studying Health System Change. This finding, drawn from HSC's 2003 Community Tracking Study Household Survey, suggested that roughly 18 million uninsured people did not know where to turn for affordable medical care when they needed it, placing them at heightened risk of going without needed treatment.

The health care safety net encompasses providers offering free or reduced-cost care to low-income and uninsured patients. The most common safety net providers include public hospitals, community health centers, and local health departments, though teaching hospitals, community hospitals, and other types of clinics may also offer charity or reduced-price care in some areas. Most office-based physicians also provide some charity care, although the proportion doing so had been declining in recent years.

Who Knows About Safety Net Providers

Among all uninsured people, those with lower incomes, racial and ethnic minorities, and people living closer to safety net providers were more likely to know of or use a safety net provider for medical care. When asked to identify sources of lower-cost care in their communities, uninsured people most frequently mentioned physician offices and community health centers. Hospital-based facilities, including outpatient departments and emergency departments, were less commonly identified as places to get affordable medical care.

This last finding was particularly notable given that uninsured people are known to use emergency departments at high rates. Despite heavy ED use by uninsured individuals, relatively few identified emergency departments as places to obtain affordable care. This disconnect suggested that many uninsured people who ended up in EDs did so out of perceived medical necessity or lack of alternatives rather than because they viewed the ED as an accessible source of affordable routine care.

Implications for Safety Net Policy

The findings highlighted the need for greater outreach and public awareness efforts to connect uninsured people with existing safety net resources. Many communities had safety net providers that could serve additional patients, but if people were unaware these resources existed, the providers could not fulfill their mission. Improved outreach could help direct uninsured individuals to appropriate primary care settings rather than leaving them to rely on emergency departments for care that could be provided more effectively and at lower cost elsewhere.

Sources and Further Reading

May, Jessica H., Peter J. Cunningham, and Jack Hadley, "Most Uninsured People Unaware of Health Care Safety Net Providers," Issue Brief No. 90, Center for Studying Health System Change (November 2004).