class1Siegel_HealthReformSaftelyNet[1] - SYMPOSIUM Health...

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SYMPOSIUM Health Reform and the Safety Net: Big Opportunities; Major Risks Bruce Siegel Marsha Regenstein Peter Shin M illions of Americans are dependent on what is often called the "safety net." These loosely-organized networks of health and social service providers serve the many Americans who are uninsured, dependent on public coverage, or for a variety of rea- sons unable to access other private systems of care. The Institute of Medicine (IOM) report, ATnerica's Health Care Safety Net: Intact but Endangered, called attention to both the fragility and the resilience of this health care safety net.^ The IOM report underscored the critical importance of the safety net to the health and well-being of millions of individuals and called for efforts to strengthen it and improve the nation's ability to monitor its viability.^ Given this central role, any health care reform efforts need to be fully informed by an under- standing of what the safety net includes, how it isfinanced, and how it is responding to a series of challenges it now faces. They also must consider the nature of the role of the health care safety net in radical health care reform, like universal coverage. As this article discusses, universal coverage would change, not eliminate, the need for the safety net. It may oifer opportunities for these providers to better meet their core missions, but such reform potentially poses major risks as well. Structure and Function of the Safety Net Populations that rely on the safety net include many of our nation's most vulnerable individuals, including the uninsured, low-income and homeless families who are at higher risk for serious illnesses than the general population, migrant farm workers, undocumented immigrants, persons vvdth chronic illnesses, and substance abusers.'' Safety net users may also reside in medically underserved areas where residents present a variety of health challenges related to high rates of unemployment, poverty, inadequate health care infrastructure, lack of access to needed services, and poor working and living con- ditions."* High infant mortality rates, poor perinatal outcomes, do- mestic violence, tobacco and alcohol related morbidity and mortal- ity, poor dental hygiene and care, substantial mental health problems, and diet and nutritionally-related illness and disease all commonly contribute to the health problems seen in communities that rely heavily on the safety net.^ There is no true consensus on what constitutes the safety net. One representative definition refers to the set of providers who "organize and deliver a significant level of health care and other health-related services to uninsured, Medicaid, and other vulnerable patients."^ Some of these providers are mandated by law to provide services re- gardless of a patient's coverage or ability to pay. Others are considered safety net providers by virtue of their organizational mission to serve uninsured, publicly insured or otherwise vulnerable patients. The
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This note was uploaded on 10/07/2010 for the course BIO 49593 taught by Professor Wanser during the Fall '10 term at University of Texas.

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class1Siegel_HealthReformSaftelyNet[1] - SYMPOSIUM Health...

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