Safety-net providers after health care reform: lessons from Massachusetts

Arch Intern Med. 2011 Aug 8;171(15):1379-84. doi: 10.1001/archinternmed.2011.317.


Background: National health reform is designed to reduce the number of uninsured adults. Currently, many uninsured individuals receive care at safety-net health care providers such as community health centers (CHCs) or safety-net hospitals. This project examined data from Massachusetts to assess how the demand for ambulatory and inpatient care and use changed for safety-net providers after the state's health care reform law was enacted in 2006, which dramatically reduced the number of individuals without health insurance coverage.

Methods: Multiple methods were used, including analyses of administrative data reported by CHCs and hospitals, case study interviews, and analyses of data from the 2009 Massachusetts Health Reform Survey, a state-representative telephone survey of adults.

Results: Between calendar years 2005 and 2009, the number of patients receiving care at Massachusetts CHCs increased by 31.0%, and the share of CHC patients who were uninsured fell from 35.5% to 19.9%. Nonemergency ambulatory care visits to clinics of safety-net hospitals grew twice as fast as visits to non-safety-net hospitals from 2006 to 2009. The number of inpatient admissions was comparable for safety-net and non-safety-net hospitals. Most safety-net patients reported that they used these facilities because they were convenient (79.3%) and affordable (73.8%); only 25.2% reported having had problems getting appointments elsewhere.

Conclusions: Despite the significant reduction in uninsurance levels in Massachusetts that occurred with health care reform, the demand for care at safety-net facilities continues to rise. Most safety-net patients do not view these facilities as providers of last resort; rather, they prefer the types of care that are offered there. It will continue to be important to support safety-net providers, even after health care reform programs are established.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Ambulatory Care / statistics & numerical data
  • Community Health Centers / statistics & numerical data
  • Community Health Services / statistics & numerical data*
  • Health Care Reform*
  • Health Care Surveys
  • Hospitals, Public / statistics & numerical data
  • Humans
  • Insurance Coverage / legislation & jurisprudence*
  • Massachusetts
  • Patient Preference*
  • Poverty Areas*
  • Uncompensated Care