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Developing Data-Driven Capabilities to Support Policymaking

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Appendix


This worksheet can form the basis for a safety net assessment in a State or locality. The information should be gathered for all geographic areas of interest as well as for any subpopulations of interest. Additional concepts and measures can be added as needed, and the measures included here can be made more specific or more general. Finally, the worksheet can be modified to allow multiple values to enable the user to assess trends over time.


Example

Concept Specific Measure Data Source Value
Size of uninsured population % of population Current Population Survey, 2001-2002 14.9% U.S.
17.4% Arizona
17.4% Florida
13.7% Oregon
12.2% Virginia

Part A: Populations

Users of Safety Net Services

Concept Specific Measure Data Source Value
  1. Size of the low-income (<200% of poverty) population.
  2. Size of the uninsured population.
  3. Size of the working uninsured population.
  4. Size of the population covered under Medicaid or SCHIP.
  5. Size of the population eligible for Medicaid or SCHIP who are not enrolled.
  6. Size of underinsured population.
  7. Size of low-income population with special health care needs.
  8. Size of low-income population by race/ethnicity.
  9. Size of low-income population with language interpretation needs.
  10. Geographic areas with large or small safety net populations.
     

Demand or Need for Safety Net Services

(If possible, specify for uninsured, low-income, and other populations of interest.)

Concept Specific Measure Data Source Value
  1. Need for primary care safety net services.
  2. Need for specialty care safety net services.
  3. Need for diagnostic testing safety net services.
  4. Need for prescription medication safety net services.
  5. Need for mental health safety net services.
  6. Need for dental care safety net services.
  7. Unmet need for any safety net services.
  8. Need for coordination of care for safety net services.
  9. Geographic areas with high or low unmet need.
     

Part B: Providers

Capacity and Distribution of Safety Net Providers

Concept Specific Measure Data Source Value
  1. Number of providers who provide the following services for uninsured patients:
    • Primary care.
    • Specialty care.
    • Diagnostic services.
    • Mental health.
    • Dental.
  2. Geographic distribution of providers who provide the following services for uninsured patients:
    • Primary care.
    • Specialty care.
    • Diagnostic services.
    • Mental health.
    • Dental.
  3. Capacity of providers to provide the following services for uninsured patients (e.g., number of appointments available per month):
    1. Primary care.
    2. Specialty care.
    3. Diagnostic services.
    4. Mental health.
    5. Dental.
  4. Number of providers who provide the following services for Medicaid patients:
    1. Primary care.
    2. Specialty care.
    3. Diagnostic services.
    4. Mental health.
    5. Dental.
  5. Geographic distribution of providers who provide the following services for Medicaid patients:
    1. Primary care.
    2. Specialty care.
    3. Diagnostic services.
    4. Mental health.
    5. Dental.
  6. Capacity of providers to provide the following services for Medicaid patients (e.g., number of appointments available per month):
    1. Primary care.
    2. Specialty care.
    3. Diagnostic services.
    4. Mental health.
    5. Dental.
  7. Availability of after-hours appointments for safety net services.
  8. Presence of public hospitals.
  9. Area hospital policies regarding discounted care for uninsured patients.
  10. Distribution of uninsured hospital visits across area hospitals.
  11. Distribution of Medicaid hospital visits across area hospitals.
  12. Geographic areas with high use of the emergency department by uninsured patients.
  13. Geographic areas with high use of the emergency department by Medicaid patients.
  14. Geographic areas with good or poor distribution of providers.
     

Part C: Funding Streams

Financing the Safety Net

Concept Specific Measure Data Source Value
  1. Level of funding for principal providers of care for the uninsured in each community.
  2. Financial viability or vulnerability of safety net.
  3. Extent of Federal Government support for the following safety net services:
    • Ambulatory care.
    • Specialty care.
    • Inpatient care.
    • Mental health.
  4. Extent of State government support for the following safety net services:
    • Ambulatory care.
    • Specialty care.
    • Inpatient care.
    • Mental health.
  5. Extent of local government support for the following safety net services:
    • Ambulatory care.
    • Specialty care.
    • Inpatient care.
    • Mental health.
  6. How Federal, State, and local safety net funds are spent.
  7. Financial health of public hospitals.
  8. Financial health of academic medical centers.
  9. Financial health of other hospitals providing substantial safety net services.
  10. Financial health of community health centers.
  11. Financial health of free clinics.
  12. Dollar value of uncompensated care per uninsured patient.
  13. Geographic areas of high or low financial vulnerability.
     

Competition

Concept Specific Measure Data Source Value
  1. Extent of commercial managed care market penetration.
  2. Extent of Medicaid managed care market penetration.
  3. Extent of Medicare managed care market penetration.
  4. Presence of for-profit hospitals.
  5. Geographic areas of high or low competition.
     

Medicaid and SCHIP

Concept Specific Measure Data Source Value
  1. Ease of enrollment and continuation of enrollment in Medicaid and SCHIP.
  2. Difficulty or ease of enrollees in finding providers who accept Medicaid.
  3. Geographic areas in which enrollees have difficulty finding a provider who accepts Medicaid.
  4. Generosity of Medicaid program (enrollment and services covered) compared to other States.
  5. Generosity of Medicaid managed care capitation rates compared to other States.
  6. Proportion of Medicaid beneficiaries enrolled in capitated managed care plans.
  7. Performance of Medicaid managed care plans vs. other managed care plans.
  8. Coordination of care within Medicaid and SCHIP.
     

Part D: Community Health and Needs Assessment

Concept Specific Measure Data Source Value
  1. Extent of racial/ethnic disparities in health care.
  2. State and local priorities for safety net care.
  3. Ability to examine health outcomes for the safety net.
  4. Ability to examine the effect of providers, capacity, and funding streams on health outcomes for safety net patients.
  5. Other issues affecting safety net services (e.g., availability of transportation).
     

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