The health care safety net—the Nation's system of providing health care to low-income and other vulnerable populations—was recently described as "intact but endangered." The Agency for Healthcare Research and Quality and the Health Resources and Services Administration are leading a joint initiative to monitor it.
The goal is to help local policymakers, planners, and analysts monitor the status of their local safety nets and the populations they serve. Strategies include providing baseline data and a set of tools that enable monitoring of the capacity and performance of local safety nets.
This fact sheet describes the activities of this Safety Net Monitoring Initiative.
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In 2000, the Institute of Medicine (IOM) released a report describing the health care safety net—the Nation's "system" of providing health care to low-income and other vulnerable populations—as "intact but endangered." In particular, the report emphasizes:
One of the five key recommendations in the report is the need for data systems and measures:
"The committee recommends that concerted efforts be directed to improving this Nation's capacity and ability to monitor the changing structure, capacity, and financial stability of the safety net to meet the health care needs of the uninsured and other vulnerable populations."1
In response, the Agency for Healthcare Research and Quality (AHRQ) and the Health Resources and Services Administration (HRSA) are leading a joint safety net monitoring initiative. An expert meeting in November 2000 provided an overview of the issues involved in establishing a monitoring system. Those attending the meeting recommended a monitoring system with four main goals:
To accomplish these goals, there is a critical need to:
The agencies involved have agreed to a three-part strategy focusing on both safety net providers and the populations they serve:
1 Lewin ME, Altman S, editors. America's health care safety net: intact but endangered. Committee on the Changing Market, Managed Care, and the Future Viability of Safety Net Providers. Washington, DC: National Academy Press; 2000.
The health care safety net consists of a wide variety of providers delivering care to low-income and other vulnerable populations, including the uninsured and those covered by Medicaid. Many of these providers have either a legal mandate or an explicit policy to provide services regardless of a patient's ability to pay.
Major safety net providers include public hospitals and community health centers as well as teaching and community hospitals, private physicians, and other providers who deliver a substantial amount of care to these populations.
One of the challenges in monitoring the Nation's health care safety net is that safety net services are provided in a myriad of different configurations, largely at the local level. As a result, the data books include information at the county and metropolitan levels, focusing on 30 States and the District of Columbia. Together, these areas cover 75 percent of the U.S. population. The books use data from a wide variety of sources to describe the status of the safety net in 90 metropolitan areas and 1,818 counties in these States.
The books provide a broad range of measures for monitoring the status of local safety nets and the populations they serve, including:
There are two data books. Book 1 focuses on metropolitan areas, providing data tables as well as analytic summaries of the measures included. Book 2 provides data for all counties (urban and rural) in the 30 States examined.
Similar to the data books, which provide information on the status of the health care safety net in metropolitan areas and counties, the tool kit (Book 3) is designed to help policy analysts and planners at the State and local levels assess the performance and needs of their local safety nets.
This publication will consist of a series of papers from experts in the field covering a wide variety of topics related to monitoring the safety net, including:
For more information about the Safety Net Monitoring Initiative, contact:
Robin M. Weinick, Ph.D.
Center for Delivery, Organization, and Markets—AHRQ
540 Gaither Road, 5th floor
Rockville, MD 20850
E-mail: safenet@ahrq.gov
or go to: www.ahrq.gov/data/safetynet/
AHRQ Publication No. 03-P011
Current as of August 2003
Internet Citation:
Safety Net Monitoring Initiative. Fact Sheet. AHRQ Publication No. 03-P011, August 2003. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/data/safetynet/netfact.htm
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