| Efforts to reform the United States' healthcare system over the last decade (2003-2013) have often called for insuring the previously uninsured indigent. Under most proposals, the financing of care for this vulnerable population shifts: from providing direct government support to facilities that deliver uncompensated care (historically, "safety net" hospitals), to empowering individuals via provision of government-supported, risk-pooled, portable insurance coverage. It is probable, however, that despite efforts for universal coverage for any population, with or without a compliance mandate, some appreciable minority will remain uninsured. Furthermore, indigents newly insured by reform-sponsored products, may not necessarily change utilization patterns or the entry points they seek for health delivery. This is the case in Massachusetts, the only American laboratory for examining such a shift of resources.;The objective of this research is to better understand the financial impact of the indigent population, pre and post health reform measures, on traditional Massachusetts safety net hospitals. To accomplish this goal, a predictor model is fitted using unprecedentedly comprehensive financial and utilization data from Massachusetts' acute safety net hospitals, pre and post their state-level 2006 health reform experiment. We find that utilization by both the uninsured indigent population (while significantly reduced in size) and the newly insured indigent population, had a much more deleterious effect on patient-care-related operating margins post-reform, than pre-reform. This fact, coupled with the reduction of direct subsidy to these facilities, calls into question the survival of these institutions, the essential services they provide, and health of the populations they serve. These results may provide policy makers and health delivery leaders a framework for more broadly understanding the utilization and financial impact of indigent care-seekers in a post-reform environment, as well as the economics of the safety net facilities that serve them. |
