Population characteristics of markets of safety-net and non-safety-net hospitals |
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Authors: | Dr Darrell J Gaskin PhD Dr Jack Hadley PhD |
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Institution: | (1) Institute for Health Care Research and Policy, Georgetown University, 2233 Wisconsin Avenue Northwest, Suite 525, 20007 Washington DC |
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Abstract: | Research Objectives To compare and contrast the markets of urban safety-net (USN) hospitals with the markets of other urban hospitals.
Study Design To develop profiles of the actual inpatient markets of hospitals, we linked 1994 patient-level information from hospital discharge
abstracts from nine states with 1990 data at the ZIP code level from the US Census Bureau. Each hospital's market was characterized
by its racial and ethnic composition, median household income, poverty rate, and educational attainment. Measures of hospital
competition were also calculated for each hospital. The analysis compared the market profiles of USN hospitals to those of
other urban hospitals. We also compared the level of hospital competition and financial status of USN and other urban hospitals.
Principal Findings The markets of USN hospitals had higher proportions of racial and ethnic minorities and non-English-speaking residents. Adults
residing in markets of USN hospitals were less educated. Families living in markets of USN hospitals had lower incomes and
were more likely to be living at or below the federal poverty level. USN hospitals and other urban hospitals faced similar
levels of competition and had similar margins. However, USN hospitals were more dependent on Medicare disproportionate share
payments and on state and local government subsidies to remain solvent.
Conclusion USN hospitals disproportionately serve vulnerable minority and low-income communities that otherwise face financial and cultural
barriers to health care. USN hospitals are dependent on the public subsidies they receive from federal, state, and local governments.
Public policies and market pressures that affect the viability of USN hospitals place the access to care by vulnerable populations
at risk. Public policy that jeopardizes public subsidies places in peril the financial health of these institutions. As Medicare
and Medicaid managed care grow, USN hospitals may lose these patient revenues and public subsidies based on their Medicaid
and Medicare patient volumes. The loss of these funds would hinder the ability of USN hospitals to finance uncompensated care
for uninsured and underinsured patients.
An earlier draft of this paper was presented as a poster at the 14th annual meeting of the Association for Health Services
Research, Chicago, IL, June 15–17, 1997.
Financial support for this research was provided by the Commonwealth Fund. The opinions expressed are solely those of the
authors and do not necessarily reflect the positions of Georgetown University and the Commonwealth Fund. |
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Keywords: | Hospital markets Minority health Safety-net hospitals Urban hospitals |
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