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Thoughts on Tranforming the Safety Net

Whilst federal reform was an instant victory for California’s uninsured and their providers of care, the future for public hospitals, public/community clinics, and other hospitals and physicians currently caring for the low-income/uninsured populations requires evolution.* As of January 1, 2014, many of the patients utilizing services through the safety net will have a greater choice of providers. Will these patients continue to access care through their current safety net providers? Will some safety net providers suffer a sharp decline in patients while others enjoy a large increase in patients?

Some clinics and hospitals are notorious for long wait times, some deliver low-quality care, and some have unresponsive management. At the same time, others deliver excellent, high-quality care at competitive prices. Conditions of some facilities are less than ideal while others are brand new. Some safety net providers are a last resort for patients who have no other access to medical care and others are the only source of care in their communities. Under federal reform, many of the safety net’s beneficiaries will no longer be compelled to rely on the safety net for their care – they will have a choice. The safety net will remain as the source of care for the residually uninsured and will still play an important role in the health care delivery system. If restructured correctly, safety net providers have the potential to not only retain their current patients, but to attract new paying patients and be an integral part of the new health care system.

*Among those who did not have insurance the past year, 48% had no usual source of care while only 11% of those who did have insurance in the past year had no usual source of care. (CHIS 2005)