Useful Resources
Safety Net Hospitals: A Snapshot
January 15, 2010
Safety net hospitals are a crucial part of the country's health care system. A safety net hospital is a hospital that serves substantially more uninsured patients and patients enrolled in Medicaid and Medicare than other hospitals. Often the term is used interchangeably with the term public hospital, an acute care hospital owned by a governmental entity, usually the county in which it's situated. However, according to the Agency for Healthcare Research and Quality (AHRQ), only about half of all safety net hospitals are public hospitals, and most of the rest are operated by private non-profit organizations.
Safety net hospitals account for a third of all hospital stays of the uninsured. A higher proportion of their patients are from racial and ethnic minority populations. Many safety net hospitals have negative or uncommonly low profit margins because reimbursement from Medicare and Medicaid doesn't usually cover the actual costs of care.
The balance is made up through local government subsidies and payments from the Medicaid and Medicare Disproportionate Share Hospital (DHS) program (federal funds paid to hospitals that serve a high percentage of low-income patients.) Twenty percent of safety net hospitals are affiliated with a medical school. Medicaid is the largest single source of funding for both safety net hospitals and public hospitals, which is why they are acutely vulnerable to cuts to Medicaid funding. Updated March 2010
Resource Links
Blogs
Frank, fascinating blog by Paul Levy, president and CEO of Beth Israel Deaconess Medical Center in Boston. Among the issues he deals with is the challenge of running a safety net hospital.
Bob Laszewski, a veteran health policy consultant, opines on federal health care policies and the health care system.
The Wall Street Journal's blog on health and the business of health, including some posts about safety net hospitals.
Advocacy
This is the primary advocacy organization for public hospitals and health systems. It publishes an annual survey on the issues facing its members. Browsing through its press releases is a good way to discover the priority issues for public and safety net hospitals.
This advocacy organization for the American hospital industry publishes press releases and reports and issues statements on hospital financing and government policies affecting hospitals.
Public Policy
The National Academies regularly publish papers on the health care safety net, including public hospitals. A March 2000 report entitled "America's Healthcare Safety Net, Intact but Endangered," is particularly useful.
Statistics, Trends and Research
This respected think tank publishes numerous studies on public and safety net hospitals.
This journal regularly publishes articles on various issues involving public and safety net hospitals.
The easily searchable CDC site offers numerous papers on the current challenges facing safety net hospitals.
Understanding Safety Net Hospitals
This nonprofit organization publishes downloadable studies that analyze the role and financial problems of public and safety net hospitals.
This is part of the Department of Health and Human Services. It has a database on hospital utilization and costs, and periodically publishes fact books on hospital issues.