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Medical Care Research and Review
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Safety-Net Hospitals

Jack Zwanziger

University of Illinois at Chicago

Nasreen Khan

University of New Mexico, Albuquerque

Vulnerable populations, who have difficulty accessing the health care system, primarily receive their medical care from hospitals. Policy makers have struggled to ensure the survival of "safety-net hospitals," hospitals that provide a disproportionate share of care to these patient populations. The objective of this article is to develop measures to guide analysis and policy for urban safety-net hospitals. The authors developed three safety-net measures: the socioeconomic status of hospital service area, Medicaid intensity, and uncompensated care burden and its market share. Cluster analysis was used to identify break points that distinguish a safety-net hospital from a non-safety-net hospital. The measures developed were stable and independent, but a data-driven binary assignment of hospitals to a "safety-net" category was not supported. These analyses call into question the empirical basis for distinguishing a specific group of hospitals as safety-net hospitals.

Key Words: safety-net hospital • vulnerable population • uninsured

Medical Care Research and Review, Vol. 65, No. 4, 478-495 (2008)
DOI: 10.1177/1077558708315440


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