The Evolution of Support for Safety-Net Hospitals

Fishman, Linda E.; Bentley, James D.

doi:10.1377/hlthaff.16.4.30

Cited by 56 publications

(47 citation statements)

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“…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%

“…Unfortunately, there is no universally accepted definition of SNHs. Many researchers have used simple organizational descriptors, such as public ownership or urban academic medical center, to define SNHs (Baxter and Mechanic 1997;Fishman and Bentley 1997;Gray 1998;Reuter and Gaskin 1998). This is problematic in that not all identified hospitals will provide substantial amounts of uncompensated care.…”

Section: Study Samplementioning

confidence: 99%

“…In particular, despite a robust economy through 2000, the percentage of the U.S. population that was uninsured changed little, from its high of 16.3% in 1998 to 14.6% in 2001 (U.S. Bureau of the Census 2002). Also, the 1997 Balanced Budget Act and some state policy actions reduced public support for safety net services (Fishman and Bentley 1997). To survive in the face of these pressures, hospitals-whether SNH or not-have had to rethink their organizational strategies and reorient their operations to remain viable.…”

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confidence: 99%

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

Bazzoli¹,

Manheim²,

Waters³

2003

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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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Section: Discussion and Study Implicationsmentioning

confidence: 99%

Section: Study Samplementioning

confidence: 99%

mentioning

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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“…16 The ratio of residents to beds was used as a proxy for determining which hospitals cared for these patients. Unfortunately, until there were BBA caps, hospitals were also given a financial incentive to increase the number of residency positions irrespective of whether they cared for more complex patients.…”

Section: Transparency and Decoupling Indirect Medical Education (Ime)mentioning

confidence: 99%

Financing Graduate Medical Education to Meet the Needs of Children and the Future Pediatrician Workforce

Pletcher¹,

Alvarado-Domenech²,

Basco³

et al. 2008

Pediatrics

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This policy statement articulates the positions of the American Academy of Pediatrics on graduate medical education and the associated costs and funding mechanisms. It reaffirms the policy of the American Academy of Pediatrics that graduate medical education is a public good and is an essential part of maintaining a high-quality physician workforce. The American Academy of Pediatrics advocates for lifelong learning across the continuum of medical education. This policy statement focuses on the financing of one component of this continuum, namely residency education. The statement calls on federal and state governments to continue their support of residency education and advocates for stable means of funding such as the establishment of an all-payer graduate medical education trust fund. It further proposes a portable authorization system that would allocate graduate medical education funds for direct medical education costs to accredited residency programs on the basis of the selection of the program by qualified student or residents. This system allows the funding to follow the residents to their program. Recognizing the critical workforce needs of many pediatric medical subspecialties, pediatric surgical specialties, and other pediatric specialty disciplines, this statement maintains that subspecialty fellowship training and general pediatrics research fellowship training should receive adequate support from the graduate medical education financing system, including funding from the National Institutes of Health and other federal agencies, as appropriate. Furthermore, residency education that is provided in freestanding children's hospitals should receive a level of support equivalent to that of other teaching hospitals. The financing of graduate medical education is an important and effective tool to ensure that the future pediatrician workforce can provide optimal heath care for infants, children, adolescents, and young adults.

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“…Some studies suggest strain on the health-care safety net because of the failure of resources to rise in tandem with demand. [10][11][12] Possible safety net stressors include: (1) rising numbers of uninsured adults, 13 (2) restricted federal funds for safety net institutions, 11 including limits on Disproportionate Share Hospital payments, 14 and (3) state and federally imposed restrictions to Medicaid program growth. 15,16 Although the number of community health centers has expanded significantly, 17 rising demand by moderate-income persons for community health center services could adversely affect homeless persons' access to these same centers, many of which receive funding under variants of the federal Health Centers Consolidation Act (typically referred to as Section 330).…”

Section: Introductionmentioning

confidence: 99%