Statement of Dr. Claude Earl Fox, Administrator, Health Resources
and Services Administration, on the Institute of Medicine Study

The Health Resources and Services Administration (HRSA) was looking for guideposts for the future when it asked the Institute of Medicine to conduct its study, America's Health Care Safety Net, Intact but Endangered, more than a year ago. The study was funded to examine the impact of a changing health care delivery system on the viability of safety net providers who have traditionally provided health care access to low income, uninsured or underinsured individuals.

The Institute of Medicine’s (IOM) fine work on this subject offers an important opportunity to assess the needs of the safety net from a holistic and innovative perspective. It explores how federal policies emanating from multiple agencies, market forces and changing demographics are converging to affect the strength and sustainability of safety net capacity. The report focuses on "core" safety net providers, such as community/migrant/homeless health centers, rural health providers, maternal and child health providers, providers of HIV/AIDS services, and health departments, that have historically received funding from HRSA.

However, as the IOM's recommendations make clear, efforts to bolster the safety net must move beyond the patchwork of programs and funding sources that support services for the uninsured and other vulnerable populations. HRSA welcomes the opportunity to work collaboratively with its sister agencies within the Department of Health and Human Services, particularly the Health Care Financing Administration, the Substance Abuse and Mental Health Services Administration, and the Centers for Disease Control and Prevention, to respond to the challenges posed by the IOM's study. While calling for a renewed commitment to investing in the safety net and a critical re-examination of current approaches, the IOM's recommendations reinforce the need for the initiatives and programs that the Administration is actively pursuing.

The President's 2001 budget includes a 10-year, $110 billion initiative to dramatically improve health care access through both expansions in health insurance coverage and increased support to safety net providers. An important component of this initiative, the new Community Access Program (CAP), is aimed at building public/private consortia and infrastructure development to promote service integration for the uninsured. Funded in fiscal year 2000 at $25 million, CAP will provide new resources to help communities coordinate core services more effectively and fill crucial service gaps. CAP grants will support the development of infrastructure, such as information systems, referral relationships and clinical protocols, that will help providers improve access to existing services and promote the efficiency of the care that is delivered. The Administration fiscal year 2001 budget includes a targeted $1 billion total budget over 5 years. Up to 100 communities may be funded under this program over the next five years with a targeted $1 billion total budget over that timeframe.

CAP is intended to strengthen existing safety net capacity primarily by building infrastructure, referral networks, information systems, and service capacity. HRSA's 3,100 community, migrant and homeless health center sites (Consolidated Health Centers) are building blocks for safety net systems nationwide. Combined with the National Health Service Corps, maternal and child health services, Ryan White activities, and other programs HRSA sponsors, these existing resources represent the backbone of many safety net systems across the country and a major source of ambulatory care for the uninsured. However, the IOM report reminds us that the configuration of our safety net varies from community to community. Thus we need to take a dual approach, first building on past strategies which have been successful, then looking more broadly, as we hope to do through the Community Access Program.

Although the IOM report clearly supports continued investment in existing safety net support mechanisms, it also calls for a critical review of current approaches to protecting the safety net at the national level. We welcome the IOM findings and recommendations and will carefully review them in conjunction with other relevant Federal agencies to determine how best to reinvigorate our efforts to strengthen the nation's safety net system.

[Note: The IOM report can be accessed on the web at http://www.nas.edu/]

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