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America's health care safety net consists of a wide variety of providers delivering care to low-income and other vulnerable populations, including the uninsured and those covered by Medicaid. Many of these providers have either a legal mandate or an explicit policy to provide services regardless of a patient's ability to pay. Major safety net providers include public hospitals and community health centers, as well as teaching and community hospitals, private physicians, and other providers who deliver a substantial amount of care to these patients.
The Nation's health care safety net was recently described by the Institute of Medicine (IOM) as "intact but endangered." In particular, the IOM cited:
- The precarious financial situation of many institutions that provide care to Medicaid, uninsured, and other vulnerable patients.
- The changing financial, economic, and social environment in which these institutions operate.
- The highly localized, "patchwork" structure of the safety net.
In response, the Agency for Healthcare Research and Quality and the Health Resources and Services Administration are leading a joint safety net monitoring initiative. The goal is to help local policymakers, planners, and analysts monitor the status of their local safety nets and the populations they serve. AHRQ and HRSA have developed two new data books that provide a broad range of measures for use in safety net monitoring. The 118 measures include:
- Demand for safety net services.
- Financial support for safety net services.
- Safety net structure and health system context.
- Community context.
- Outcomes and safety net performance.
The data books include information at the county and metropolitan levels, focusing on 30 States and the District of Columbia and covering 75 percent of the U.S. population. The books use data from a wide variety of sources to describe the status of the safety net in 90 metropolitan areas and all 1,818 counties within the States examined. Book 1 focuses on metropolitan areas, and book 2 provides county-level data.
The data books, a fact sheet, electronic data sets and documentation, and frequently asked questions are available on the Web at www.ahrq.gov/data/safetynet/. The Web site also includes the Safety Net Profile Tool, a user-friendly, online tool that allows users to create their own custom reports using data from the two books. With this tool, users can generate reports that compare multiple measures for one or more geographic areas.
In addition, AHRQ and HRSA are developing a tool kit to help policy analysts and planners at the State and local levels assess the status of their safety nets. The tool kit will consist of nine commissioned papers authored by experts in the field, and will be available later this year.
Select for more information about the safety net monitoring initiative.
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