January 2001

Grant Results

SUMMARY

From 1995 to 1997, staff from the Alpha Center for Health Planning and the People-to-People Health Foundation (now called Project HOPE) sponsored a conference and published papers on the future financing of two critical health system functions in the United States — namely, uncompensated care for those without insurance and graduate medical education.

Key Results

  • Project staff from the Alpha Center for Health Planning organized a two-day conference entitled "What's Happening to the Safety Net? Recent Trends and Emerging Financing Options." Held on January 9–10, 1997, in Washington, the conference was attended by some 125 people.
  • The July/August 1997 issue of Health Affairs focused on the topic "The Safety Net versus the Market: Is the Safety Net in Crisis?" The special issue included papers from the conference, articles commissioned by the journal, and other articles.

Funding
The Robert Wood Johnson Foundation (RWJF) supported this project through two grants:

  • $79,396 to the Academy for Health Services Research and Health Policy.
  • $196,984 to the People-to-People Health Foundation.

 See Grant Detail & Contact Information
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THE PROBLEM

Uncompensated care for those without insurance and graduate medical education have both traditionally have been supported in part by cross-subsidies, such as charges to private and government insurance programs for professional services and hospital care provided for enrollees.

The growth during the 1980s and 1990s of for-profit managed care and competition in health care created uncertainty about how those functions — called safety-net functions would be financed.

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THE PROJECT

Under the first grant (ID# 027409), staff at the Academy for Health Services Research and Health Policy organized a two-day conference that examined the evolution and role of academic medical centers as traditional safety-net providers.

The second grant (ID# 026525) funded a special issue of the health-care-policy journal Health Affairs on the topic "The Safety Net versus the Market: Is the Safety Net in Crisis?"

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RESULTS

First Grant (ID# 027409)

  • Project staff organized a two-day conference entitled "What's Happening to the Safety Net? Recent Trends and Emerging Financing Options."

    Held on January 9–10, 1997, in Washington, the conference was attended by some 125 people, including:
    • Senior officials of the US Department of Health and Human Services (DHHS).
    • Congressional staff members.
    • Safety-net hospital administrators.
    • Health care providers.
    • Health policy analysts.
    • Health foundation professionals.

    The conference offered baseline information on the evolution and role of academic medical centers as traditional safety-net providers. Conference topics included:
    • The evolution of subsidies for uncompensated care and graduate medical education.
    • The impact of changes in health care delivery and financing on providers' delivery of care and education.
    • Responses by local delivery systems.
    • New options to finance graduate medical education and uncompensated care.
    • Two views on federal responsibilities for safety-net support.

    Twenty-nine health care analysts and practitioners presented results from recent research, discussed their experiences with market and public policy pressures, and offered opinions on how to ensure the survival of a health care safety net. Presenters included:
    • Raymond Baxter
    • Mark Finucane
    • Phyllis Busansky
    • David Helms
    • Jamie Reuter
    • Ron Anderson
    • David Jaffe

    (See the Bibliography for details.)

Second Grant (ID# 026525)

  • The July/August 1997 issue of Health Affairs focused on the topic "The Safety Net versus the Market: Is the Safety Net in Crisis?" The special issue included papers from the conference, articles commissioned by the journal, and other articles.

    The contents covered a broad range of topics related to the impact of managed care on the health care safety net — for example, covering uninsured children, funding the safety net, Medicaid managed care, and mental health coverage. (See the Bibliography for details.)

    The special issue was distributed to more than 9,300 paid subscribers and an additional 2,000 health care policy makers and researchers. It was also:
    • Publicized in a press release to 250 organizations reporting on health care.
    • Promoted on the Health Affairs Web site.
    • Promoted at the conference of the National Managed Care Congress, an educational forum on the managed health care industry, and at annual meetings of the Association for Health Services Research and the American Association of Health Plans.
    • Advertised in the American Journal of Public Health and Modern Healthcare.

    Three letters responding to the issue were published in subsequent issues. Several presentations from the conference were featured in a health care trade newsletter, Medicine and Health Perspectives, in January 1997.

    John K. Iglehart, founding editor of Health Affairs, reported that information in the special issue was used as a reference in high-level meetings of DHHS on safety-net and Medicaid issues within a week of the issue's release.

    Also, an article in the issue comparing the costs of various incremental approaches with expansion of children's health insurance coverage helped members of Congress understand the magnitude of the number of uninsured children in the United States and the relatively small cost to insure them.

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AFTER THE GRANT

Health Affairs continues to publish extensively on children's health insurance and the role of safety-net providers and Medicaid managed care. For example:

  • The November/ December 1998 issue reported on a study of Medicaid managed care programs in rural areas across the country.
  • An article on the financing of academic health centers appeared in the March/April 1999 issue.
  • The September/October 1999 issue included an article exploring why employment-based health insurance coverage for children increased in the mid-1990s.

The journal also published several articles with new information on safety net providers in the July/August 2000 issue. Health Affairs' January/February 2001 issue is a special thematic issue on health insurance coverage developed with support from RWJF (ID# 033554).

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GRANT DETAILS & CONTACT INFORMATION

Project

Conference and Report on the Impact of Price Competition on the Health Care System

Grantee

Academy for Health Services Research and Health Policy, Inc. (Washington,  DC)

  • National Invitational Conference on the Impact of Price Competition
    Amount: $ 79,396
    Dates: July 1995 to January 1997
    ID#:  027409

Contact

David Helms, Ph.D.
(202) 296-1818
helms@ac.org

Grantee

People-to-People Health Foundation, Inc. (Millwood,  VA)

  • Health Affairs Issue on the Impact of Price Competition in Managed Care on the Larger Health Care System
    Amount: $ 196,984
    Dates: September 1995 to December 1997
    ID#:  026525

Contact

John K. Iglehart
(301) 656-7401
healthaffairs@projecthope.org

Web Site

http://www.healthaffairs.org

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Health Affairs. Special issue: "The Safety Net versus the Market: Is the Safety Net in Crisis?" 16(4): 1997. Washington, D.C.: People-to-People Health Foundation, Inc. (Project HOPE). 11,342 copies mailed. Articles in the special issue of Health Affairs:

  • Allen HM and Rogers WH. "The Consumer Health Plan Value Survey: Round Two," pp. 156–166.
  • Anderson RJ. "Perspective: Beyond the Safety Net in Dallas," pp. 27–29.
  • Andrulis DP. "The Public Sector in Health Care: Evolution or Dissolution?" pp. 131–140.
  • Atkinson G, Helms WD, and Needleman J. "State Trends in Hospital Uncompensated Care," pp. 233–241.
  • Baxter R and Mechanic R. "The Status of Local Health Care Safety Nets," pp. 7–23.
  • Buck JA and Umland B. "Trends: Covering Mental Health and Substance Abuse Services," pp. 120–126.
  • Cunningham PJ and Tu HT. "A Changing Picture of Uncompensated Care," pp. 167–175.
  • Dembe AE, Himmelstein JS, Stevens BA, and Beacher MP. "Improving Workers' Compensation Health Care," pp. 253–257.
  • Desmarais HR and Hash MM. "Financing Graduate Medical Education: The Search for New Sources of Support," pp. 48–63.
  • Fishman LE. "What Kinds of Hospitals Form the Safety Net?" pp. 215–222.
  • Fishman LE and Bentley JD. "The Evolution of Support for Safety-Net Hospitals," pp. 30–47.
  • Flint SS. "Perspective: Insuring Children: The Next Steps," pp. 79–81.
  • Frank R, Koyanagi C, and McGuire T. "The Politics and Economics of Mental Health 'Parity' Laws," pp. 108–119.
  • Gabow P. "Perspective: Denver Health: Initiatives for Survival," pp. 24–26.
  • Ginsburg PB and Pickreign JD. "Tracking Health Care Costs: An Update," pp. 151–155.
  • Greenberg J and Zuckerman B. "State Health Care Reform in Massachusetts," pp. 188–193.
  • Iglehart JK. "Politics and Compromise: Sen. Jim F. Jeffords."
  • Kihlstrom LC. "Trends: Characteristics and Growth of Managed Behavioral Health Care Firms," pp. 127–130.
  • Libby DL, Zhou Z, and Kindig DA. "Will Minority Physician Supply Meet US Needs?" pp. 205–214.
  • Lipson DJ. "Medicaid Managed Care and Community Providers: New Partnerships," pp. 91–107.
  • Mann JM, Melnick GA, Bamezai A, and Zwanziger J. "A Profile of Uncompensated Hospital Care, 1983–1995," pp. 223–232.
  • McCall N. "Lessons from Arizona's Medicaid Managed Care Program," pp. 194–199.
  • Mick SS and Lee SYD. "The Safety-Net Role of International Medical Graduates," pp. 141–150.
  • Reuter J and Gaskin D. "Academic Health Centers in Competitive Markets," pp. 242–252.
  • Robinson JC. "Use and Abuse of the Medical Loss Ratio to Measure Health Plan Performance," pp. 176–187.
  • Rosenbaum S. "A Look inside Medicaid Managed Care Contracts," pp. 266–271.
  • Thorpe KE. "Incremental Approaches to Covering Uninsured Children: Design and Policy Issues," pp. 64–78.
  • Wilson MJ and Kizer KW. "The VA Health Care System: An Unrecognized National Safety Net," pp. 200–204.

Schroeder SA. "The Medically Uninsured — Will They Always Be with Us?" New England Journal of Medicine, 334(7): 1130–1133, 1996.

Sponsored Conferences

"What's Happening to the Safety Net? Recent Trends and Emerging Financing Options," January 9–10, 1997, Washington, D.C. Attended by approximately 125 people from congressional staffs; federal agencies, in particular the Department of Health and Human Services; providers; safety net hospitals; and health foundations.

Presentations:

  • Raymond Baxter, "The Future of the Health Care Safety Net in a Changing Environment."
  • Dennis Andrulis, "The Public Sector and the Emerging Health Care Environment: Evolution or Dissolution?"
  • Mark Finucane, "Los Angeles County's Response to Competition for Medicaid Patients and Diminishing Public Subsidies to Care for the Vulnerable Population: Early Implementation Experiences in 1,115 Waiver Restructurings."
  • Phyllis Busansky, "Hillsborough County Health Care Plan."
  • Patricia Gabow, "Characteristics of Denver and Its Marketplace."
  • James Campbell, "Status of Safety Net Providers in Tennessee."
  • Michael Hash and Henry Desmarais, "Financing Medical Education: An Overview of Policy Options and Issues."
  • David Helms, Graham Atkinson, and Jack Needleman, "Uncompensated Care in Selected States: Recent Trends and Policy Responses."
  • Judith Arnold, "Health Care Financing Reforms."
  • James Bentley and Linda Fishman, "The Evolution of Support for Uncompensated Care and Graduate Medical Education."
  • Joyce Mann, "Hospital Uncompensated Care under Managed Care, Competition, and Fiscal Pressure."
  • Jamie Reuter, "What Is Happening to the Safety Net? Impact on Academic Health Centers' Delivery of Care and Education."
  • Ron Anderson, "What Is Happening to the Safety Net?"
  • David Jaffe, "Harborview Medical Center."

Press Kits and News Releases

Health Affairs distributed a news release highlighting its July/August 1997 special issue "The Safety Net versus the Market" in July 1997 to 250 national health care press.

The American Hospital Association distributed a news release highlighting a study on children's health insurance that appeared in the July/August issue of Health Affairs on July 14, 1997, to more than 100 national health care press people.

"The Safety Net versus The Market," July 1997. Available online.

Print Coverage

"AHCs on Edge as Congress Meets, Market Pressure Builds," Medicine and Health Perspectives, January 13, 1997.

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Report prepared by: Mike Meagher
Report prepared by: Janet Heroux
Reviewed by: David Kales
Reviewed by: Molly McKaughan
Program Officer: Rosemary Gibson