How Did Safety-Net Hospitals Cope In The 1990s?

Zuckerman, Stephen; Bazzoli, Gloria J.; Davidoff, Amy J.; LoSasso, Anthony T.

doi:10.1377/hlthaff.20.4.159

Cited by 64 publications

(79 citation statements)

References 6 publications

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“…The algorithm we used to designate hospitals as safety-net providers combined the concept of utilization by safety-net payer groups used by Darrell Gaskin and Jack Hadley 26 and the market importance criteria developed by Stephen Zuckerman and colleagues. 27 Lastly, we used a hospital-level measure of casemix acuity, calculated by CMS, to control for the average severity of admissions in each hospital.…”

Section: Study Data and Methodsmentioning

confidence: 99%

The Quality Of Care Delivered To Patients Within The Same Hospital Varies By Insurance Type

2013

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In attempting to explain why hospitals vary in the quality of care delivered to patients, a considerable body of health policy research points to differences in hospital characteristics such as ownership, safetynet status, and geographic location as the most important contributing factors. This article examines the extent to which a patient's type or lack of insurance may also play a role in determining the quality of care received at any given hospital. We compared within-hospital quality, as measured by risk-adjusted mortality rates, for patients according to their insurance status. We examined the Agency for Healthcare Research and Quality's innovative Inpatient Quality Indicators and pooled 2006-08 State Inpatient Database records from eleven states. We found that privately insured patients had lower risk-adjusted mortality rates than did Medicare enrollees for twelve out of fifteen quality measures examined. To a lesser extent, privately insured patients also had lower risk-adjusted mortality rates than those in other payer groups. Medicare patients appeared particularly vulnerable to receiving inferior care. These findings suggest that to help reduce care disparities, public payers and hospitals should measure care quality for different insurance groups and monitor differences in treatment practices within hospitals.

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Section: Study Data and Methodsmentioning

confidence: 99%

The Quality Of Care Delivered To Patients Within The Same Hospital Varies By Insurance Type

2013

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“…As has happened in the past following coverage expansion, newly insured patients may leave safety-net providers that fail to deliver high quality, patient-centric care. 13 is will result in lost revenue from these newly insured patients. At the same time, special payments to providers who serve a safety-net population, such as disproportionate share hospital (DSH) payments, are likely to be reduced (since these payments serve in large part to support care for the uninsured).…”

Section: Hospital Vignette: Virginia Mason Integrated Care Processesmentioning

confidence: 99%

Fostering a Commitment to Quality: Best Practices in Safety-net Hospitals

Hochman¹,

Briggs-Malonson²,

Wilkes³

et al. 2016

hpu

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In 2007, the Martin Luther King, Jr.-Harbor Hospital (MLK-Harbor), which served a large safety-net population in South Los Angeles, closed due to quality challenges. Shortly therea er, an agreement was made to establish a new hospital, Martin Luther King, Jr. Community Hospital (MLKCH), to serve the unmet needs of the community. To assist the newly appointed MLKCH Board of Directors in building a culture of quality, we conducted a series of interviews with ve high-performing hospital systems. In this report,

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“…We obtained access to these items through a subcontract with the AHA's Health Research and Educational Trust, which is the AHA's research and educational affiliate. 7 Zuckerman et al (2001) used an adjusted market share measure because market shares are highly dependent on the number of hospitals in a market. Namely, if there were four hospitals in a market and all had equal uncompensated care market share, each would provide 25% of uncompensated care; but if there were 10 hospitals in a market with equal uncompensated care market shares, each would have a 10% share.…”

Section: Discussion and Study Implicationsmentioning

confidence: 99%

“…The adjustment used by Zuckerman and his colleagues was straightforward, namely multiplying each hospital's uncompensated care market share by the number of hospitals in its market, which eliminates the effect of varying numbers of hospitals per market. 8 Specifically, Zuckerman et al (2001) followed Fishman and Bentley (1997) and used the top decile of the percentage of hospital expenses that were uncompensated in a given year as the threshold for high uncompensated care expense and used a value of 2 for adjusted market share as a threshold for high uncompensated care market share. See Zuckerman et al (2001: 160-161) for more elaboration and justification of these specific thresholds.…”

Section: Discussion and Study Implicationsmentioning

confidence: 99%

“…7 Zuckerman and his colleagues used thresholds for the percentage of hospital expenses that were uncompensated and for the hospital's adjusted market share of uncompensated care based on the work of Fishman (1997), and their own examination of the distributions of these variables. 8 An advantage of the threshold-based approach of Zuckerman et al (2001) is that it identifies a distinct group of hospitals deemed ''SNHs'' that can be contrasted with ''non-SNHs.'' The use of thresholds to create sharp distinctions is problematic though, because these are hard and fast boundaries that may not reflect diversity across markets and over time.…”

Section: Study Samplementioning

confidence: 99%

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U.S. Hospital Industry Restructuring and the Hospital Safety Net

Bazzoli¹,

Manheim²,

Waters³

2003

INQUIRY

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The U.S. hospital industry was reshaped during the 1990s, with many hospitals becoming members of health systems and networks. Our research examines whether safety net hospitals (SNHs) were generally included or excluded from these arrangements, and the factors associated with their involvement. Our analysis draws on the earlier work of Alexander and Morrisey (1988), and not only studies factors affecting SNH participation in multihospital arrangements but also updates their earlier study. We constructed measures for hospital market conditions, management, and mission, and examined network and system affiliation patterns between 1994 and 1998. Our findings suggest that larger and more technically advanced hospitals joined systems in the 1990s, which contrasts with 1980s findings that smaller, financially weak institutions joined systems. Further, SNH participation in networks and systems was more common when hospitals faced less market pressure and where only a limited number of unaffiliated hospitals remained. If networks and systems are key parties in negotiating with private payers, SNHs may be going it alone in these negotiations in highly competitive markets.

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How Did Safety-Net Hospitals Cope In The 1990s?

Cited by 64 publications

References 6 publications

The Quality Of Care Delivered To Patients Within The Same Hospital Varies By Insurance Type

The Quality Of Care Delivered To Patients Within The Same Hospital Varies By Insurance Type

Fostering a Commitment to Quality: Best Practices in Safety-net Hospitals

U.S. Hospital Industry Restructuring and the Hospital Safety Net

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