Key Policy Area 2 - Access to Care for the Uninsured
Rising numbers of uninsured will increase the burden on safety net providers. These hospitals, community health centers and other organizations are stretched thin already and are facing financial pressures from managed care and cuts in federal subsidies. Through site visits and the CTS Household Survey, HSC monitors the capacity and financial viability of the safety net as markets become more competitive, insurance expansions are implemented and innovative ways to provide uncompensated care— such as through managed care—are put in place. Drawing on the CTS Physician Survey, HSC also examines the role doctors play in providing charity care and how that care may be evolving under managed care and other market forces. How might a Bush Administration initiative— that includes an expansion of the safety net through community health centers and tax credits—enhance coverage while improving access to care for those who remain uninsured? Earlier HSC research suggests that expansions in insurance coverage are more effective in improving access for the uninsured than expanding direct care services. HSC is continuing research in this area by examining variation across markets in the use of insurance expansions versus directly supporting the safety net and assessing the effectiveness of these different approaches. The results of these and related studies will provide policy makers with a clearer picture of how successful the mixed approach may be in improving access, or whether it reinforces the existing two-tier system of care. As these changes unfold, ongoing tracking of uninsured persons’ ability to access care will provide a strong indicator of whether the safety net, while frail, remains largely intact HSC’s current research suggests—or is fraying and putting people in jeopardy. Related Publications by HSC Staff Issue Brief No.38 May 2001Emergency Room Diversions: A Symptom of Hospitals Under Stress
by Linda R. Brewster, Liza S. Rudell and Cara S. Lesser Issue Brief No. 34 January 2001
Race, Ethnicity and Preventive Services: No Gains for Hispanics
by J. Lee Hargraves Data Bulletin No. 19 October 2000
Some Communities Make Progress in Reducing Children's Uninsurance
by Michael H. Park and Peter J. Cunningham
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"The most troubling trend is the increase in uninsured low-income parents
who, unlike their children, do not have access to public programs," said
Peter Cunningham, author of a study on the uninsured that showed a significant
increase in the percentage of uninsured working parents - from 31 percent to 35
percent between 1997 and 1999. —Associated Press, April 24, 2000
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