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Debra J. Lipson


Naomi Naierman


Staying in the Game:

March 1999
Research Report No. 03

Association Leaders Speak Out on Health System Change

January/February 1997
Health Affairs

The Community Snapshots Project

March 1996
Compilation of Snapshots

Snapshots of Change in Fifteen Communities:

Effects of Health System Changes on Safety-Net Providers

Summer 1996
Health Affairs, vol.15, no.2 (Summer 1996): 33-48
Debra J. Lipson, Naomi Naierman

rowing competition in health care markets and Medicaid managed care, combined with cuts in government funds that subsidize care to the uninsured, are challenging the viability of the safety net. In response to these pressures, "safety net" providers in fifteen communities are integrating vertically and horizontally, contracting with or forming managed care plans, and seeking to attract paying patients. Such strategies appear to be successful for community- based primary care clinics, but other providers - including hospitals that cannot quickly develop primary care capacity, most local health departments, and providers that fail to attract Medicaid patients - are more vulnerable to health system changes. While the safety net may be intact now, access to care among the uninsured is more at risk in communities without state programs of local taxes that subsidize such care.

Free access to this article is available at the Health Affairs Web site.


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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.