Local public hospitals: changing with the times.

Research brief Pub Date : 2012-11-01
Laurie E Felland, Lucy Stark
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Abstract

Over the last 15 years, public hospitals have pursued multiple strategies to help maintain financial viability without abandoning their mission to care for low-income people, according to findings from the Center for Studying Health System Change's (HSC) site visits to 12 nationally representative metropolitan communities. Local public hospitals serve as core safety net providers in five of these communities--Boston, Cleveland, Indianapolis, Miami and Phoenix--weathering increased demand for care from growing numbers of uninsured and Medicaid patients and fluctuations in public funding over the past 15 years. Generally, these public hospitals have adopted six key strategies to respond to growing capacity and financial pressures: establishing independent governance structures; securing predictable local funding sources; shoring up Medicaid revenues; increasing attention to revenue collection; attracting privately insured patients; and expanding access to community-based primary care. These strategies demonstrate how public hospitals often benefit from functioning somewhat independently from local government, while at the same time, relying heavily on policy decisions and funding from local, state and federal governments. While public hospitals appear poised for changes under national health reform, they will need to adapt to changing payment sources and reduced federal subsidies and compete for newly insured people. Moreover, public hospitals in states that do not expand Medicaid eligibility to most low-income people as envisioned under health reform will likely face significant demand from uninsured patients with less federal Medicaid funding.

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地方公立医院:与时俱进。
根据研究卫生系统变化中心(HSC)对12个具有全国代表性的大都市社区的实地考察的结果,在过去的15年里,公立医院采取了多种策略,以帮助维持财务可行性,同时又不放弃照顾低收入人群的使命。在波士顿、克利夫兰、印第安纳波利斯、迈阿密和凤凰城这五个社区中,当地公立医院作为核心安全网的提供者,经受住了过去15年里,由于越来越多的无保险和医疗补助患者对医疗服务的需求不断增加,以及公共资金的波动。一般来说,这些公立医院采取了六项关键战略来应对不断增长的能力和财政压力:建立独立的治理结构;确保可预测的地方资金来源;增加医疗补助收入;增加对税收的重视;吸引私人保险患者;扩大以社区为基础的初级保健服务。这些战略表明,公立医院往往从某种程度上独立于地方政府运作中受益,同时又严重依赖地方、州和联邦政府的政策决定和资金。虽然公立医院在国家医疗改革下似乎做好了改变的准备,但它们需要适应不断变化的支付来源和减少的联邦补贴,并争夺新参保的人。此外,在那些没有按照医疗改革的设想将医疗补助资格扩大到大多数低收入人群的州,公立医院可能会面临来自没有保险的患者的大量需求,这些患者的联邦医疗补助资金较少。
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If the price is right, most uninsured--even young invincibles--likely to consider new health insurance marketplaces. High and varying prices for privately insured patients underscore hospital market power. The surge in urgent care centers: emergency department alternative or costly convenience? Emergency preparedness and community coalitions: opportunities and challenges. Local public hospitals: changing with the times.
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