America's Children Health Insurance and Access to Care (1998) / Chapter Skim
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4 Safety Net Providers
4 Safety Net Providers
Pages 65-80
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From page 65... ...
port tin~ncin:3 ~le~ltl1 C are for CllilUren
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From page 67... ...
The mix of services also differs clepencling on the community's provider base, its commitment to serving low~income anc3 uninsured groups, anc3 incliviclual providers' ability to participate. This chapter of the report describes the sources anc3 amounts of financing for safety net providers anc3 then describes the general utilization rates and patterns for four types of safety net proviclers: community health centers, chilclren's hospitals, health clepartments, and school~basecl health centers.
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From page 68... ...
Uncompensatecl care costs are becoming more concentrated among fewer hospitals anc3 other traditional safety net providers, anc3 there also is a significant increase in the amount of uncompensated care proviclec3 byincliviclualphysicians (Cunningham anc3 Ha, 1997~. Table 4.!
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From page 69... ...
69 Cot CD a)
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From page 70... ...
Thus, the availability of care for the increasing numbers of uninsured children and adults will be further concentrated among safety net providers. COMMUNITY HEALTH CENTERS Under Section 330 of the Public Health Service Act, community health centers (CHCs)
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From page 71... ...
. TABLE 4.2 National Cost of Uncompensated Care for Registered Community Hospitals, United States, 1987-1995 Uncompensated Care Cost Year (in millions of dollars)
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From page 72... ...
The Balanced Budget Act of 1997 introclucec3 provisions that will change the structure of Meclicaic3 anc3 make a significant impact on community health centers. Cost- based reimbursement was important to CHCs because CHC patients tend to have multiple problems anc3 their treatment tencis to be more expensive, anc3 also because CHCs offer more expanciec3 services than most commercial plans, including translation, case management, anc3 other support services.
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From page 73... ...
Q 1.0 0.5 o.o THE NUMBER OF MEDICAID PATIENTS DOUBLED AND THE NUMBER OF UNINSURED PATIENTS INCREASED SUBSTANTIALLY AFTER 1990 1~.1 ·~.1 ·~.1 ~ 1~1 1 hn.E ·~a ·~.
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From page 74... ...
. TABLE 4.4 Community Health Center (CHC)
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From page 75... ...
Depending on your state or community, public health programs for children may be called maternal and child health, family health, or community health, but they are all involved in ensuring access to care. The dollars flow through local health departments, health centers, visiting nurses associations, school-based clinics, and other groupswhoever is out there in a community, we'll work with them.
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From page 76... ...
. HOSPITAL REVENUES HAVE INCREASED STEADILY SINCE 1991 250 ~ 200 In ~ = O 150 ~ o tY ~1 u, .0 1 00 50 o N =29 ~- 1 1 Total Inpatient _ ~ ~ Outpatient 1 991 1 992 1993 Year 1994 1 995 FIGURE 4.5 Average gross revenue per freestanding acute-care children's hospital, United States, 1991-1995.
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From page 77... ...
, school~basec3 health clinics, and other services (see Figure 4.6 and Table 4.6~. There are health departments that do classic public health functions, but in many areas of the country they also deliver health services, some of which are funded by Medicaid, some by state dollars, some by Title V or grant dollars or Title XX.
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From page 78... ...
SOURCE: NACCHO, 1995. TABLE 4.6 Percentage of City and County Health Departments Offering Selected Health Care Programs (N = 2,092)
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From page 79... ...
Uncompensatecl care costs are not generally broken clown by age group, but the number of uninsured children has been increasing steadily for several years. With the new chilciren's health insurance programs initiated through the Balanced Budget Act of 1997, states that increase their Meclicaic3 eligibility thresholds anc3 otherwise subsidize coverage for previously uninsured children can raise the rates of insurance coverage anc3 thus reduce the burden of providing uncompensated care among safety net providers.
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From page 80... ...
Alexandria, VA: NACHRI. NACHC (National Association of Community Health Centers)
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