Altarum's Private Insurance Research Collection

Commissioned Research

Reform of Hospital Safety-Net Subsidies to Enhance Care to Uninsured and Low-Income Patients and Promote Health Equity, Sayeh Nikpay, Melinda Buntin, Vanderbilt University School of Medicine

Safety-net hospitals provide a disproportionate share of care for low income and uninsured populations. Despite historic reductions in the number of uninsured in 2014, 27.3 M Americans remain without insurance and low-income insured Americans struggle to pay co-insurance and deductibles. Safety-net hospitals play an important role in providing care to populations that cannot afford medical care, absorbing a reported $38.3B in uncompensated care annually. Safety-net subsidies can promote health equity for under-served communities by reducing barriers to accessing care. The accuracy with which safety-net subsidy payments are targeted to hospitals that serve large numbers of uninsured and low-income patients is poorly understood. We will use administrative data on all general acute care, Medicare-certified hospitals in the U.S. to estimate correlations between provision of safety-net care (defined as charity care, uncompensated care, and provision of low-profit but high community value services such as psychiatric care) and existing metrics determining eligibility for subsidies, including the disproportionate share hospital patient percentage, the Medicaid patient fraction, and the low-income patient fraction. We will determine the number of hospitals that receive multiple safety-net subsidies as well as their characteristics. We focus specifically on health equity by conducting additional analyses that focus on hospitals that serve low-income populations and have a high potential to promote health equity through greater access to care for low-income populations. 7/1/18 – 7/14/19