America's health care safety net: intact but endangered
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Washington, DC
National Acad. Press
2000
|
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XVIII, 281 S. Ill., graph. Darst. |
| ISBN: | 030906497X |
Staff View
MARC
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| 245 | 1 | 0 | |a America's health care safety net |b intact but endangered |c Committe on the Changing Market, Managed Care, and the Future Viability of Safety Net Providers, Institute of Medicine. Marion Ein Lewin ... eds. |
| 264 | 1 | |a Washington, DC |b National Acad. Press |c 2000 | |
| 300 | |a XVIII, 281 S. |b Ill., graph. Darst. | ||
| 336 | |b txt |2 rdacontent | ||
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| 650 | 4 | |a Medically uninsured |z United States | |
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Record in the Search Index
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|---|---|
| adam_text | EXECUTIVE SUMMARY 1
1 BACKGROUND AND OVERVIEW 16
Background, 16
Approach to the Study, 18
Organization of the Report, 20
Key Definitions, Study Parameters, and Caveats, 21
Program and Policy Overview, 29
2 THE CORE SAFETY NET AND THE SAFETY NET SYSTEM 47
The Health Care Safety Net, 49
The Special Value of Core Safety Net Providers, 70
Safety Net Providers in a Changing Health Care Environment, 74
3 FORCES AFFECTING SAFETY NET PROVIDERS IN A
CHANGING HEALTH CARE ENVIRONMENT 81
Increasing Demand for Care, 84
Uncertainties in Public Support, 98
Changing Structure and Environment of the Health
Care Marketplace, 106
Conclusion, 126
xv
I
xvi CONTENTS !
4 HOW SAFETY NET PROVIDERS ARE ADAPTING TO j
THE NEW ENVIRONMENT 132 j
The Changing Medicaid Managed Care Marketplace, 134 j
Safety Net Provider Participation in Managed Care, 136 j
New Federal Safety Net Initiative, 152 ¦
Importance of State and Local Policies, 153 i
5 THE IMPACT OF CHANGE ON VULNERABLE
POPULATIONS 159
Access, Quality, and Satisfaction, 162
Nonfinancial Barriers to Access to Health Care, 166
Improving the Scope and Content of Beneficiary Choice, 166
How Effective Are Current Enrollment and Choice Policies?, 169
Mainstreaming, 170
The Uninsured Population, 173
Innovative New Approaches to Care for the Uninsured
Population, 174
Other Challenges, 175
6 SAFETY NET POPULATIONS WITH SPECIAL HEALTH
AND ACCESS NEEDS 180
People with Special Needs, 181
Lessons Learned, 198
Generalizations to the Larger Safety Net System, 200
7 FINDINGS AND RECOMMENDATIONS 205
Findings, 206
Recommendations, 212
APPENDIXES
A Committee Biographies 221
B Workshop Agenda 227
C Workshop Participants 234
D California Regional Meeting Agenda 243
E California Regional Meeting Participants 244
F New York Regional Meeting Agenda 249
G New York Regional Meeting Participants 253
H Rural Conference Call Participants 258
I Acronyms 260
INDEX 263
CONTENTS XVii
TABLES, FIGURES, AND BOXES
Figures
! 2.1 Changes in health center Medicaid and uninsured patients by rev
; enue source, 1985 1997, 50
2.2 Ethnic and racial composition of urban safety net hospital market
areas, 1994, 52
2.3 Payor source, income, and racial characteristics of FQHC patients,
1997, 53
3.1 Forces affecting the health care safety net, 82
3.2 Number of uninsured nonelderly Americans (in millions), 1987 to
1998, 85
3.3 Employers offering health insurance and worker participation, 1987
to 1996, by wage of workers, 87
3.4 Trends in Medicaid coverage and a lack of health insurance cover¬
age, 1987 to 1998,88
3.5 Variations in percentage of nonelderly uninsured among U.S. states
and the District of Columbia, 1998, 90
3.6 Rate of growth in Medicaid enrollment by eligibility group, 1990 to
1997,94
3.7 Percentage changes in selected states Medicaid enrollment, 1995 to
1997,96
3.8 Medicaid spending on DSH payments, 1990 to 1996, 99
3.9 Average net revenues from select sources at NAPH member hospi¬
tals, 1993 to 1997,104
3.10 Trends in state and local subsidies and uncompensated care costs at
NAPH member hospitals, 1991 to 1997,105
3.11 Percentage of HMOs reporting a profit, 1988 to 1997,110
3.12 Change in safety net hospitals market shares of Medicaid and unin¬
sured patients, 1991 to 1994,115
3.13 Medicaid and self paying patient discharges as a percentage of total
discharges at NAPH member hospitals, 1993 to 1997,118
3.14 Actual and projected declines of total Medicare margins for public
hospitals as a result of the BBA of 1997,119
3.15 Percentage growth in numbers of uninsured compared with 1990
levels: rates for CHCs versus national rates, 123
6.1 Percentage of nonelderly persons with disabilities (PWD) in Medic¬
aid managed care, 1998,183
6.2 Medicaid enrollees and expenditures by enrollment group, 1996,
184
xoiii contents
Tables
2.1 Revenue for Public Versus Private Hospitals, 58
2.2 Patients by Revenue Source: Physicians and Federally Qualified
Health Centers, 61
3.1 Changes in the Balanced Budget Act (BBA) of 1997 Phaseout of
Health Center Cost Based Reimbursement Made by the BBA Refine¬
ments Act of 1999,102
3.2 Hospital Gains and Losses by Payer, by Hospital Group, 1992,116
3.3 Hospital Gains and Losses by Payer, by Hospital Group, 1997,117
3.4 Trends in Federally Qualified Health Center Revenue, 1990 1998,
120
3.5 Trends in Federally Qualified Health Center Users, 1990 1998,121
3.6 Trends in Federally Qualified Health Center Revenues per Patient
User, 1990 1998,121
Boxes
1.1 Medicaid Managed Care: Selected Provisions in the Balanced Bud¬
get Act of 1997, 36
2.1 The Core Safety Net Serves a Wide Range of Vulnerable Popula¬
tions, 51
2.2 Funding Sources for a Major Urban Safety Net Health System, Den¬
ver Health, 56
2.3 Funding Sources for a Rural Safety Net System, Rural Health Group,
Inc., 57
4.1 Safety Net Providers: Keys to Successful Adaptation and Future
Viability in a Managed Care Environment, 155
5.1 Characteristics of Medicaid Managed Care That Make It Different
from Commercial Managed Care, 161
5.2 Lessons Learned from Managed Care Enrollment, 168
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| spelling | America's health care safety net intact but endangered Committe on the Changing Market, Managed Care, and the Future Viability of Safety Net Providers, Institute of Medicine. Marion Ein Lewin ... eds. Washington, DC National Acad. Press 2000 XVIII, 281 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Delivery of Health Care United States Medical Assistance United States Medical assistance United States Medical care Needs assessment United States Medically Uninsured United States Medically uninsured United States Poor Medical care United States Medizinische Versorgung (DE-588)4038270-9 gnd rswk-swf USA USA (DE-588)4078704-7 gnd rswk-swf USA (DE-588)4078704-7 g Medizinische Versorgung (DE-588)4038270-9 s DE-604 Lewin, Marion E. Sonstige oth HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=009151308&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | America's health care safety net intact but endangered Delivery of Health Care United States Medical Assistance United States Medical assistance United States Medical care Needs assessment United States Medically Uninsured United States Medically uninsured United States Poor Medical care United States Medizinische Versorgung (DE-588)4038270-9 gnd |
| subject_GND | (DE-588)4038270-9 (DE-588)4078704-7 |
| title | America's health care safety net intact but endangered |
| title_auth | America's health care safety net intact but endangered |
| title_exact_search | America's health care safety net intact but endangered |
| title_full | America's health care safety net intact but endangered Committe on the Changing Market, Managed Care, and the Future Viability of Safety Net Providers, Institute of Medicine. Marion Ein Lewin ... eds. |
| title_fullStr | America's health care safety net intact but endangered Committe on the Changing Market, Managed Care, and the Future Viability of Safety Net Providers, Institute of Medicine. Marion Ein Lewin ... eds. |
| title_full_unstemmed | America's health care safety net intact but endangered Committe on the Changing Market, Managed Care, and the Future Viability of Safety Net Providers, Institute of Medicine. Marion Ein Lewin ... eds. |
| title_short | America's health care safety net |
| title_sort | america s health care safety net intact but endangered |
| title_sub | intact but endangered |
| topic | Delivery of Health Care United States Medical Assistance United States Medical assistance United States Medical care Needs assessment United States Medically Uninsured United States Medically uninsured United States Poor Medical care United States Medizinische Versorgung (DE-588)4038270-9 gnd |
| topic_facet | Delivery of Health Care United States Medical Assistance United States Medical assistance United States Medical care Needs assessment United States Medically Uninsured United States Medically uninsured United States Poor Medical care United States Medizinische Versorgung USA |
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