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Chapter 9. The Declining Public Hospital Sector

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The Health Care Safety Net in a Post-Reform World
This chapter is in the book The Health Care Safety Net in a Post-Reform World
200Public hospitals have long served as the backbone of the health care safety net,caring for the poor, uninsured, and racial and ethnic minorities, as well as pro-viding critical regional services. In major metropolitan areas, public hospitalsprovide more than 20 percent of emergency and 33 percent of outpatient visits, as well as 60 percent of burn and 36 percent of trauma care. Medicaidand uninsured patients account for more than 50 percent of all public hospitalvisits (NAPH 2009). In rural areas, they are major components of local healthsystems, representing nearly 40 percent of hospitals. Public hospitals have also traditionally provided extensive outpatient services, community publichealth programs, and culturally and linguistically appropriate care.Under health reform, there will continue to be a need for safety-net hos-pital services. It has been estimated that, following the implementation ofhealth reform, 23 million Americans will still be uninsured and 16 million will be covered by Medicaid or the State Children’s Health Insurance Program,populations historically reliant on public hospitals (CBO 2010).In the wake of the 2008 recession, state and local governments have beenunder financial pressure, which has in turn threatened the financial stability ofpublic hospitals. State and local budget crises have prompted large cutbacks in funding for many institutions while the number of uninsured and those covered by Medicaid have grown at record rates (Hartocollis 2010; KFF 2010;Skipp 2010; Sun and Mummolo 2010).Prior to the economic downturn, public hospitals were already battlingfinancial and political pressures to survive in an increasingly cost-drivenhealth care market, and many were closed or converted to private ownershipThe Declining Public Hospital SectorChapter 9Jack Needleman and Michelle Ko
© 2019 Rutgers University Press, New Brunswick

200Public hospitals have long served as the backbone of the health care safety net,caring for the poor, uninsured, and racial and ethnic minorities, as well as pro-viding critical regional services. In major metropolitan areas, public hospitalsprovide more than 20 percent of emergency and 33 percent of outpatient visits, as well as 60 percent of burn and 36 percent of trauma care. Medicaidand uninsured patients account for more than 50 percent of all public hospitalvisits (NAPH 2009). In rural areas, they are major components of local healthsystems, representing nearly 40 percent of hospitals. Public hospitals have also traditionally provided extensive outpatient services, community publichealth programs, and culturally and linguistically appropriate care.Under health reform, there will continue to be a need for safety-net hos-pital services. It has been estimated that, following the implementation ofhealth reform, 23 million Americans will still be uninsured and 16 million will be covered by Medicaid or the State Children’s Health Insurance Program,populations historically reliant on public hospitals (CBO 2010).In the wake of the 2008 recession, state and local governments have beenunder financial pressure, which has in turn threatened the financial stability ofpublic hospitals. State and local budget crises have prompted large cutbacks in funding for many institutions while the number of uninsured and those covered by Medicaid have grown at record rates (Hartocollis 2010; KFF 2010;Skipp 2010; Sun and Mummolo 2010).Prior to the economic downturn, public hospitals were already battlingfinancial and political pressures to survive in an increasingly cost-drivenhealth care market, and many were closed or converted to private ownershipThe Declining Public Hospital SectorChapter 9Jack Needleman and Michelle Ko
© 2019 Rutgers University Press, New Brunswick

Chapters in this book

  1. Frontmatter i
  2. Contents vii
  3. List of Figures ix
  4. List of Tables xi
  5. Chapter 1. The Health Care Safety Net in the Context of National Health Insurance Reform 1
  6. Part I. Community Health Centers
  7. Chapter 2. Dr. StrangeRove; or, How Conservatives Learned to Stop Worrying and Love Community Health Centers 21
  8. Chapter 3. Reinventing a Classic: Community Health Centers and the Newly Insured 67
  9. Chapter 4. Applying Lessons from Social Psychology to Repair the Health Care Safety Net for Undocumented Immigrants 91
  10. Chapter 5. Community Health Center and Academic Medical Partnerships to Expand and Improve Primary Care 108
  11. Chapter 6. Examining the Structure and Sustainability of Health Care Safety-Net Services 126
  12. Part II. Safety-Net Hospitals
  13. Chapter 7. Safety-Net Hospitals at the Crossroads: Whither Medicaid DSH? 153
  14. Chapter 8. The Safety-Net Role of Public Hospitals and Academic Medical Centers: Past, Present, and Future 183
  15. Chapter 9. The Declining Public Hospital Sector 200
  16. Part III. Safety-Net Systems
  17. Chapter 10. Achieving Universal Access through Safety-Net Coverage 217
  18. Chapter 11. Public Coverage Expansions and Private Health Insurance Crowd-Out: Implications for Safety Nets 234
  19. About the Contributors 261
  20. Index 265
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https://doi.org/10.36019/9780813553177-011

Chapters in this book

  1. Frontmatter i
  2. Contents vii
  3. List of Figures ix
  4. List of Tables xi
  5. Chapter 1. The Health Care Safety Net in the Context of National Health Insurance Reform 1
  6. Part I. Community Health Centers
  7. Chapter 2. Dr. StrangeRove; or, How Conservatives Learned to Stop Worrying and Love Community Health Centers 21
  8. Chapter 3. Reinventing a Classic: Community Health Centers and the Newly Insured 67
  9. Chapter 4. Applying Lessons from Social Psychology to Repair the Health Care Safety Net for Undocumented Immigrants 91
  10. Chapter 5. Community Health Center and Academic Medical Partnerships to Expand and Improve Primary Care 108
  11. Chapter 6. Examining the Structure and Sustainability of Health Care Safety-Net Services 126
  12. Part II. Safety-Net Hospitals
  13. Chapter 7. Safety-Net Hospitals at the Crossroads: Whither Medicaid DSH? 153
  14. Chapter 8. The Safety-Net Role of Public Hospitals and Academic Medical Centers: Past, Present, and Future 183
  15. Chapter 9. The Declining Public Hospital Sector 200
  16. Part III. Safety-Net Systems
  17. Chapter 10. Achieving Universal Access through Safety-Net Coverage 217
  18. Chapter 11. Public Coverage Expansions and Private Health Insurance Crowd-Out: Implications for Safety Nets 234
  19. About the Contributors 261
  20. Index 265
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