Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #109902

Marsha Regenstein, PhD and Jennifer Huang, MS. National Public Health and Hospital Institute, 1301 Pennsylvania Avenue, NW, Suite 950, Washington, DC 20004, 202-585-0135, jhuang@naph.org

The downturn in the economy over the past several years has placed increasing stress on safety net hospital systems. This study describes trends affecting the financial viability of safety net hospitals, which are extremely dependent upon public sources of financing, as they face increasing demand for their services. Data was drawn primarily from the annual surveys of members of the National Association of Public Hospitals and Health Systems (NAPH) and the American Hospital Association. In-depth interviews were also conducted with hospital leaders and department directors in safety net hospitals in eight geographically diverse states. Approximately 120 public and not-for-profit safety net hospitals that are members of NAPH were included in the study. These hospital systems collectively accounted for nearly 1.5 million discharges, 30 million outpatient visits, and over 5 million emergency department visits in 2002. About 42% of outpatient visits are to patients who are uninsured and another 27% are covered by Medicaid. Safety net hospitals have implemented numerous programs to improve efficiencies and leverage scarce resources. Increasingly, however, public hospitals are dependent on federal Medicaid revenues for their financial health and are extremely sensitive to Medicaid changes both at the federal and state level. Hospital leaders indicate that they have few options for increasing revenue from other payer sources. Most juggle the need for direct care with the need for capital improvements, including advances in information technology. With growing demand from vulnerable populations, efforts to curtail federal support will have profound and immediate effects on safety net hospitals' ability to maintain current services within their communities. Without sustained support from public sector financing, public hospitals will be forced to limit service availability, limit eligibility for free or reduced care, or reduce quality of care.

Learning Objectives:

• Describe the effects of the recent economic downturn on the financial situation of safety net hospitals and on their clients.
• List programs that safety net hospital leaders have taken to improve efficiencies and leverage financial resources.
• Discuss the effect of declining Medicaid funding on safety net hospitals and their patients.

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.