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Health Care Costs and Financing

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Hospital emergency departments play a critical role in monitoring the Nation's health care safety net

An Institute of Medicine (IOM) report called the health care safety net in the United States "intact but endangered" in 2000. In response to IOM recommendations to monitor the safety net, the Agency for Healthcare Research and Quality, Health Resources and Services Administration, and Office of the Assistant Secretary for Planning and Evaluation of the U.S. Department of Health and Human Services began a joint safety net monitoring initiative in an expert meeting on November 9, 2000.

The hospital emergency department (ED) will be one key source of data for this monitoring, as EDs provide a considerable proportion of the country's safety net services. Although the role of the ED as a safety net for uninsured patients has been well documented, it is not clear how the ED functions to provide ongoing, regular care for low-income populations. Several questions remain unanswered. For example, why and how do safety net patients rely on the ED to provide preventive care, urgent acute care, and nonurgent acute care, and to what extent do EDs have the resources to provide for this care without constraining their ability to provide emergency care to other patients?

Among the many other questions that need to be answered are how the ED fits into other systems of care; whether ED data can be monitored on an ongoing basis to understand trends and provide early warning of impending health care crises, particularly those that may affect safety net populations; and whether EDs can help monitor system failures within the safety net. The development and integration of data systems that include relevant clinical information from ED encounters will be crucial to creating a dynamic, policy-relevant monitoring system for the safety net. Also, collaboration between the health services research and emergency medicine communities will be critical to accomplishing this goal, conclude Robin M. Weinick, Ph.D., and Helen Burstin, M.D., M.P.H., of AHRQ's Center for Primary Care Research. They suggest ways for meeting these challenges in a recent article.

See "Monitoring the safety net: Data challenges for emergency departments," by Drs. Weinick and Burstin, in the November 2001 Academic Emergency Medicine 8(11), pp. 1019-1021.

Reprints (AHRQ Publication No. 02-R017) are available from the AHRQ the AHRQ Publications Clearinghouse.

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