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Every year, more than 10 million people receive care from public hospitals and health systems – a complex and diverse set of providers that share a mission to deliver health services to individuals, regardless of insurance coverage or ability to pay. Together with federally funded health centers, free clinics, public health departments and scores of individual physicians and other health practitioners, public hospitals provide critical access points for the nation's uninsured population and form a vast patchwork of providers that is commonly referred to as the health care safety net. Despite their importance, there is no single or stable source of financial support for public hospitals' service to their communities. Safety net financing is fragmented; consequently, providers must knit together resources from many different funding sources to create a stream of revenue to cover the costs of providing a very broad range of services. Part 1 of this report describes those sources of revenue, demonstrating the significant role Medicaid plays in supporting the current public hospital safety net, documenting that nearly 40% of all safety net revenues are from Medicaid. It also highlights trends affecting the health of the safety net over the past decade. Part 2 describes particular challenges that safety net hospitals and health systems are experiencing as they attempt to rebound from the economic downturn of the early 2000s.


Funder: Kaiser Commission on Medicaid and the Uninsured.

Additional copies of this report (#7329) are available on the Kaiser Family Foundation's website at

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