Thanks to strong, businesslike leadership, community support and political will, local healthcare safety nets for the poor and the uninsured actually have grown stronger since 1995, according to a new report from the Center for Studying Health System Change.
The center is a Washington-based, not-for-profit research group funded by the Robert Wood Johnson Foundation.
However, budgetary pressures on governments, hospitals and physicians alike pose a major threat to the stability of the system, the study says.
"While local safety nets generally are stronger, the true test lies ahead as states grapple with budget deficits and demand for safety-net care increases because of the sluggish economy," HSC President Paul Ginsburg says.
The study looks at conditions in 12 cities and areas that HSC says are "nationally representative": Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y.
HSC researchers report that most safety-net healthcare providers in those communities increased their capacity to provide primary and acute care between 1995 and 2003, though specialty, mental health and dental services are more limited.
The economic boom of the late 1990s and political will helped funnel money into federal, state and local programs for the indigent and the uninsured, including the State Children's Health Insurance Program and Medicaid systems, according to the study.
At the same time, improved business practices of public and community hospitals and clinics have allowed facilities making up safety nets to operate more efficiently, thus providing more care.
This business acumen may help healthcare safety nets weather the current economic downturn that has led to budgetary crises in nearly all states and at the federal level, as well as to a decline in the number of physicians willing to provide charity care, the HSC researchers say.