Responses of safety net providers to profit-driven competition and their effects on access

Over the past decade, the capacity of safety net hospitals and community health centers has been largely sustained and even expanded to care for more patients through public policy initiatives and innovative organizational strategies. Yet, these providers continue to face challenges from an ever-growing demand for care from marginalized populations due to the dysfunctional U.S. health care system, exacerbated by changing policies and harsh market conditions. How has the safety net responded to this environment and how have these responses affected access to health services? This presentation synthesizes four papers from the Round Six site visits of the Community Tracking Study (CTS) conducted between February and June 2007, describing key safety net developments and highlighting their policy implications. Since 1996, the CTS provides longitudinal information on local health system change in 12 nationally representative metropolitan communities. The site visits entail in-depth interviews with about 500 individuals across the communities, representing a wide variety of views from grassroots organizations to health care providers and clinicians to insurers and purchasers to elected officials. The study design allows researchers to explore variation across markets while also identifying national trends. CTS is conducted by the Center for Studying Health System Change and funded by The Robert Wood Johnson Foundation. The author is a consulting researcher with the Center. Analyses of CTS Round Six data focus on: 1) market pressures facing safety net providers and the tradeoffs they are making to try to both maintain their mission and remain financially viable; 2) how community health centers are tackling rising demands and expectations; 3) efforts by emergency departments at safety net hospitals to manage or redirect patients with non-emergent conditions; and 4) gaps in dental services for low-income people and the ways communities and safety net providers are attempting to develop these services. Safety net providers are integral components of a community's health system – their survival and that of other providers are interdependent. As the number of people without health coverage or with inadequate financial protection grows, these pressures will continue to threaten access to needed services and heighten the need for market-wide solutions.