Recent Trends and Geographic Variation in the Safety Net

Marquis, M. Susan; Rogowski, Jeannette; Escarce, José J.

doi:10.1097/01.mlr.0000124243.59446.5e

Cited by 28 publications

(25 citation statements)

References 15 publications

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“…In addition, policies oriented toward enhancing funding for the safety net and increasing the capacity of safety net providers are likely to be important to ensuring access among the urban uninsured. Researchers have reported a relatively stable trend in safety net capacity in the late 1990s through 2001 (Felland et al 2003), but the absolute level of capacity has been shown to vary widely across communities (Marquis et al 2004), and some research suggests that those disparities may be widening over time (Hoadley, Felland, and Staiti 2004). Increasing budgetary pressures at the federal level and in many states are likely to pose an increasing threat to safety net funding.…”

Section: Discussionmentioning

confidence: 99%

Healthcare Markets, the Safety Net and Access to Care Among the Uninsured

Gresenz

Rogowski

Escarce

2004

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Objective: To quantify the relationship between access to care among the uninsured and the structure of the local health care market and safety net. Conclusions: Facilitating transport to safety net providers and increasing the number of such providers are likely to improve access to care among the rural uninsured. Our findings for urban areas suggest that the uninsured living in areas where managed care presence is substantial, and especially where managed care competition is limited, could be a target for policies to improve access to care. Policies oriented toward enhancing funding for the safety net and increasing the capacity of safety net providers are likely to be important to ensuring access among the urban uninsured. Data

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Section: Discussionmentioning

confidence: 99%

Healthcare Markets, the Safety Net and Access to Care Among the Uninsured

Gresenz

Rogowski

Escarce

2004

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“…We measured safety-net capacity using the level of local government spending for health and hospitals in the metropolitan area. 11,17 Spending was scaled to the population with income Ͻ200% of the federal poverty line and was based on data obtained from the Census of Governments and the Annual Survey of State and Local Government Finances. We measured the primary care physician (PCP) supply in the local area as the sum of family practitioners, pediatricians, and general practitioners per thousand people in the county.…”

Section: Discussionmentioning

confidence: 99%

Dimensions of the Local Health Care Environment and Use of Care by Uninsured Children in Rural and Urban Areas

2006

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OBJECTIVE. Despite concerted policy efforts, a sizeable percentage of children lack health insurance coverage. This article examines the impact of the health care safety net and health care market structure on the use of health care by uninsured children.METHODS. We used the Medical Expenditure Panel Survey linked with data from multiple sources to analyze health care utilization among uninsured children. We ran analyses separately for children who lived in rural and urban areas and assessed the effects on utilization of the availability of safety net providers, safety net funding, supply of primary care physicians, health maintenance organization penetration, and the percentage of people who are uninsured, controlling for other factors that influence use.RESULTS. Fewer than half of uninsured children had office-based visits to health care providers during the year, 8% of rural and 10% of urban children visited the emergency department at least once, and just over half of children had medical expenditures or charges during the year. Among uninsured children in rural areas, living closer to a safety net provider and living in an area with a higher supply of primary care physicians were positively associated with higher use and medical expenditures. In urban areas, the supply of primary care physicians and the level of safety net funding were positively associated with uninsured children's medical expenditures, whereas the percentage of the population that was uninsured was negatively associated with use of the emergency department.CONCLUSIONS. Uninsured children had low levels of utilization over a range of different health care provider types and settings. The availability of safety net providers in the local area and the safety net's capacity to serve the uninsured influence access to care among children. Possible measures for ensuring access to health care among uninsured children include increasing the density of safety net providers in rural areas, enhancing funding for the safety net, and policies to increase primary care physician supply. Nonetheless, an alarming number of children remain without health insurance coverage, with recent estimates placing the number of uninsured children at between 9 and 10 million, or ϳ12% to 13% of all children. 2,3 That such a substantial number of children remain uninsured reflects restrictions on eligibility for public insurance as well as incomplete uptake of health insurance coverage by children who are eligible for it. By some accounts, as many as two thirds of uninsured children are eligible for but not enrolled in Medicaid or the State Children's Health Insurance Program, despite substantial efforts to strengthen outreach and streamline administrative processes. 2,3 Compared with children who have health insurance coverage, uninsured children are less likely to have a usual source of care, to have any contact with a physician during a given year, to receive care in circumstances in which care seems warranted (eg, for an ear infection), to receive prescriptio...

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“…[2][3][4][5][6] A review of this literature identified fourteen candidate programs for study, which in turn led us to additional programs. With advice from a national panel of safety-net experts, we selected model safety-net programs for uninsured people with incomes of up to 250 percent of the federal poverty level in four communitiesAsheville, North Carolina; Denver, Colorado; Flint, Michigan; and San Antonio, Texas.…”

Section: Study Data and Methodsmentioning

confidence: 99%

Model Safety-Net Programs Could Care For The Uninsured At One-Half The Cost Of Medicaid Or Private Insurance

2011

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Because the reforms under the Affordable Care Act of 2010 will leave an estimated twenty million or more people still uninsured, some Americans will continue to seek care at low or no cost through existing safety-net systems. To identify appropriate care models, this comparative case study assessed the costs of care provided by four large, wellstructured, comprehensive safety-net programs for the uninsured in Colorado, Michigan, North Carolina, and Texas. The average monthly resource cost-including the value of referred, donated, and in-kind services-in these model programs was $141-$209 per adult in 2008. This was 25-50 percent less than the estimated cost of care for comparison groups covered by local Medicaid programs or by private insurance that provided similar services. Although these programs' services are somewhat less comprehensive than those of generous insurance plans, the findings suggest that these model safety-net programs could be adapted to provide an alternative type of coverage for the uninsured, including both low-income and middle-class people.

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Recent Trends and Geographic Variation in the Safety Net

Abstract: Local financing capacity is a factor in variations across communities in the safety net. The economic downturn and pressures on state budgets could lead to future problems.

Cited by 28 publications

References 15 publications

Healthcare Markets, the Safety Net and Access to Care Among the Uninsured

Healthcare Markets, the Safety Net and Access to Care Among the Uninsured

Dimensions of the Local Health Care Environment and Use of Care by Uninsured Children in Rural and Urban Areas

Model Safety-Net Programs Could Care For The Uninsured At One-Half The Cost Of Medicaid Or Private Insurance

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