The Costs and Adequacy of Safety Net Access for the Uninsured: Exeter and Portsmouth, New Hampshire (Sea Care)
The health care safety net is commonly referred to but less frequently defined. Throughout this area of our Web site, we use the term to include health care providers that deliver care in a variety of settings to a diverse group of people. These providers include public hospitals, community health centers, local health departments, free clinics, special service providers, and in some cases, physician networks and school-based clinics that deliver care to low-income, vulnerable patients.
Although many receive state and federal funding, safety nets are locally organized and managed, giving rise to a patchwork of systems with little coordination and integration. At the same time, they serve unique local needs and are attuned to the needs of the population they serve.
In May 2009, the Robert Wood Johnson Foundation (RWJF) awarded Mark A. Hall, J.D., professor of public health sciences at Wake Forest University, a two-year grant to examine well-functioning safety nets that provide low-income patients affordable access to comprehensive care.
As part of the project, several case studies highlight better-functioning safety nets in both metropolitan and rural settings. The safety net systems examined include Boston Medical Center's CareNet program in Boston, Mass.; Denver Health in Denver, Colo.; CareLink in San Antonio, Texas; Project Access in Asheville, N.C.; Genesee Health Plan in Flint, Mich.; Care Partners in south coastal Maine; and SeaCare in Exeter and Portsmouth, New Hampshire. Each case study assesses how these systems allow for low-income uninsured people to have access to a fairly complete range of medical services and evaluates the available data regarding the structure, adequacy and costs of the systems.
Despite the passage of the federal health reform legislation, an estimated 20 million people will likely remain uninsured and reliant on safety net care, making the efficacy of the nation’s health care safety net a vital issue for policy-makers and health care advocates. As a result, a well-constructed and coordinated network of safety net providers can be a model to provide care to those who remain un- or under-insured.