The Status of Local Health Care Safety Nets

Baxter, Raymond J.; Mechanic, Robert E.

doi:10.1377/hlthaff.16.4.7

Cited by 79 publications

(63 citation statements)

References 3 publications

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“…5 We suspect that those who are concerned about the viability of safety-net primary care clinics are making an important observation about the decline in numbers of Medi-Cal patients at these clinics but that they are drawing the wrong conclusion about why it is occurring. Our analysis suggests that safety-net primary care clinics in California are indeed seeing a decline over time in their number of Medi-Cal clients.…”

Section: Discussionmentioning

confidence: 99%

Medicaid Managed Care's Impact On Safety-Net Clinics In California

et al. 2000

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A growing percentage of Medicaid patients are receiving medical care within a managed care system. This policy change has raised concerns about whether safety-net providers can maintain their share of Medi-Cal (California Medicaid) patients. From 1995 to 1997 several of California's counties implemented mandatory Medi-Cal managed care. The majority of California's safety-net primary care clinics experienced a decline in the percentage of their patients insured by Medi-Cal. However, after the overall decline in the number of Medi-Cal beneficiaries was controlled for, the increased penetration of MediCal managed care in a county was not independently associated with a decline in clinics' share of Medi-Cal patients. Despite this fact, it may become increasingly difficult for clinics to maintain their current level of services with declining Medi-Cal enrollment and other anticipated reforms in their funding.H e a l t h c a r e p r o v i s i o n f o r p o o r and historically underserved communities in California is changing rapidly. As is true in most states, a substantial proportion of MediCal (California Medicaid) beneficiaries have changed or are in the process of changing from a program of traditional fee-for-service (FFS) reimbursement to enrollment in managed care plans. The

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Section: Discussionmentioning

confidence: 99%

Medicaid Managed Care's Impact On Safety-Net Clinics In California

et al. 2000

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“…(Baxter & Mechanic, 1997;Gold, 1999;Hurley & Somers, 2003;Lipson & Naierman, 1996;Sparer & Brown, 2000) The reason for this concern centered around the notion that Medicaid managed care might change the composition of safety-net providers' caseloads (and thereby their sources of funding) such that it would reduce these providers' ability to cross-subsidize care. During the late 1990s and early 2000s, a number of case studies were conducted to measure the impact on safety-net facilities.…”

Section: Medicaid Managed Care and The Safety-netmentioning

confidence: 99%

A Leak in the Lifeboat: The effect of Medicaid managed care on the vitality of safety-net hospitals

Woodworth

2016

J Regul Econ

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States are increasingly adopting Medicaid managed care in efforts to address budgetary concerns. The intent is that by releasing Medicaid oversight to private organizations, competition will drive down healthcare expenditures so that savings may be passed to the state. Yet there are concerns that this competitive solution to cost savings might compromise safety-net hospitals. Managed care organizations cut costs by restricting the providers that enrollees are allowed to see. If movement in Medicaid patients disrupts safety-net hospitals' casemix, this could affect their ability to cross-subsidize care. This study estimates the impact of Medicaid managed care on safety-net hospitals by exploiting a Florida pilot program that required Medicaid recipients in five counties to enroll in managed care. The results suggest this mandate led to a small reduction in safety-net hospitals' average ratio of payment-to-cost. There is also some evidence that the effect on safetynet hospitals was disproportionate. This disproportionality was such that hospitals nearest the margin were pushed the furthest towards the edge.

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“…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%

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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The Status of Local Health Care Safety Nets

Cited by 79 publications

References 3 publications

Medicaid Managed Care's Impact On Safety-Net Clinics In California

Medicaid Managed Care's Impact On Safety-Net Clinics In California

A Leak in the Lifeboat: The effect of Medicaid managed care on the vitality of safety-net hospitals

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

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