This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Will It Be There If We Need It?

Joel Weissman, PhD

JAMA. 1996;276(10):823-828.

Abstract
The debates over health care system reform continue, but they rarely mention the enduring need for free or reduced-cost hospital care as a safety net for uninsured and underinsured individuals. Policy changes on numerous fronts threaten the ability or willingness of hospitals to provide uncompensated care. These changes include the decline of Hill-Burton funds, the closings or mergers of not-for-profit and public hospitals, the dominance of competitive forces, and the redirection of funds intended for disproportionate share hospitals or uncompensated pools. Federal and state governments lack coordinated approaches toward uncompensated care, and health system reforms may not have the expected effects on reducing hospitals' burden of paying for services to indigents. Furthermore, measurement of uncompensated care is inconsistent. In light of the persistent growth in the number of persons with inadequate health insurance coverage and the central role that uncompensated care will continue to play in ensuring access to care for the poor and uninsured, these policies need to be reexamined. Guidelines for policy based on past experience are presented herein.

Author Affiliations
From the Department of Health Care Policy, Harvard Medical School, and Division of General Medicine (Section on Health Services Research), Department of Medicine, Brigham and Women's Hospital, Boston, Mass.

Footnotes
Reprints: Joel S. Weissman, PhD, Department of Health Care Policy, 25 Shattuck St, Parcel B, First Floor, Boston, MA 02115.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

TREADWELL ET AL. RESPOND
Treadwell et al.
AJPH 2004;94:907-908.
FULL TEXT  

Hospital Provision of Uncompensated Care and Public Program Enrollment
Blewett et al.
Med Care Res Rev 2003;60:509-527.
ABSTRACT  

Limits To The Safety Net: Teaching Hospital Faculty Report On Their Patients' Access To Care
Weissman et al.
Health Aff (Millwood) 2003;22:156-166.
ABSTRACT | FULL TEXT  

Charity Care: Do Not-for-Profits Influence for-Profits?
Clement et al.
Med Care Res Rev 2002;59:59-78.
ABSTRACT  

Final Report of the FOPE II Financing of Pediatric Education Workgroup
Jones Jr. et al.
Pediatrics 2000;106:1256e-1256.
ABSTRACT | FULL TEXT  

Community Considerations: The Many Effects of Miscoding
Rifkin
JAMA 1999;282:1676-1679.
FULL TEXT  

Trends in Health Care Coverage and Financing and Their Implications for Policy
Smith
NEJM 1997;337:1000-1003.
FULL TEXT  

Ensuring Health Care for the Uninsured
Bierman
JAMA 1996;276:1804-1804.
ABSTRACT