In Four Major Cities, Providers to the Poor Just Barely Keep Up With Demand

Analysis of options to help remake the health care safety net: Part II

During 1995 and 1996, researchers at the Lewin Group, a health care and social services consulting firm based in Falls Church, Va., took a snapshot of the state of the health care safety net in four urban areas: Dallas, Los Angeles, Memphis, and New York City.

The research team also made program development recommendations to the Robert Wood Johnson Foundation (RWJF) regarding the maintenance and improvement of the health care safety net.

A similar grant was awarded to Kalkines, Arky, Zall, & Bernstein (ID# 027417) to assess the viability of the safety net in three other cities (Boston, Miami, Philadelphia) and also in New York City.

Key Findings:

  • Safety-net providers delivered a wide range of services, but an integrated "net" was noticeably absent.
  • Public hospitals provided the majority of safety-net services in the four cities visited.
  • Although only Los Angeles' health care safety net was considered by Lewin to be "in crisis" (in New York a crisis was thought to be imminent; in Memphis the safety net was under pressure; and in Dallas there was not a crisis), the level of need for health care services was considered high in all four cities.
  • Leadership was a key component for stability of safety-net systems.
  • More primary care capacity was needed but there were many barriers to its development.
  • Integration of health care delivery with public-health functions was difficult.
  • Most safety-net providers were not well positioned for managed care.
  • The rapid implementation of Medicaid managed care had shaken up health care delivery, but because of a lack of data, its impact on indigent care was uncertain.

Key Recommendations

  • The research team recommended that RWJF fund a concept they called the safety network, which would introduce a neutral agency that could provide information and technical assistance and promote communication and cooperation among urban safety net providers.