The Special Role of Urban Safety-Net Hospitals
The U.S. today has a vast, multi-part health care safety net. Among the major participants in this safety-net are public and children’s hospitals; federally qualified health centers and other government-sponsored clinics; sole-community, Medicare-dependent, and critical access hospitals; and others. Urban safety-net hospitals are a vital part of this health care safety net as well. These private, non-profit, mission-driven institutions are key providers for many uninsured, under-insured, low-income, and Medicare- and Medicaid-dependent residents of urban areas throughout the country. Without private urban safety-net hospitals, millions of Americans would have very limited access to medical care.
Typically, private urban safety-net hospitals serve alongside public hospitals in their communities, providing the same services to the same patients for the same reimbursement – if they are paid at all. Most urban communities do not have any public hospitals, leaving private, non-profit urban safety-net hospitals standing alone as the providers of last resort for people who have nowhere else to turn for care.
Urban safety-net hospitals benefit the entire nation. Many have teaching programs through which they train our next generation of physicians. They also are deeply involved in medical research, playing a pivotal role in developing the medical breakthroughs that will improve the quality of life for millions in the years to come.
Urban Safety-Net Hospitals: Going Above and Beyond
Non-profit urban safety-net hospitals operate in areas that the health care market has otherwise abandoned, providing care to the low-income residents of their communities because others have abandoned those communities and the residents who remain still need care but have nowhere else to turn. Urban safety-net hospitals recognize that they do so at their own peril and that they are risking their financial viability and perhaps their very futures. They do it anyway.
Hospitals typically only provide services if they feel they can make money on those services – but not private urban safety-net hospitals. These hospitals routinely provide money-losing services – maternity and neonatal intensive care, behavioral health and substance services, care for AIDS patients, burn and trauma services, and more – for the simple reason that their communities need these services and no one else is willing to provide them. Their emergency rooms are among the busiest in the country, with vast numbers of those emergency patients having no way to pay for the care they receive.
While caring for disproportionate numbers of low-income and disadvantaged patients, urban safety-net hospitals routinely provide services that no payment system in the world recognizes and for which no payment system in the world will compensate them. Their patients benefit greatly from help with transportation, social work services, on-site translators, and child care; instruction in nutrition and visits and telephone calls to the homes of young, pregnant women from nurses and other health care professionals; classes on raising children and special programs for low-income seniors; and much, much more.
Many urban safety-net hospitals are much more than ordinary community hospitals: they are tertiary-care institutions that offer cutting-edge treatment that takes advantage of the latest in health care technology and knowledge. They are pioneers in new ways of treating injuries and diseases and are the hospitals to which other hospitals transfer their most complicated cases. For these reasons, they attract patients from well beyond the borders of their own communities, making them a vital resource for entire regions of insured and uninsured patients alike.
Finally, private urban safety-net hospitals are almost always the economic engines that drive their communities. Often, they are the only institution of great size in their communities – communities that other businesses have long abandoned for more lucrative markets elsewhere.