Safety-net providers after health care reform: Lessons from Massachusetts

Document Type

Response or Comment

Publication Date



Archives of Internal Medicine


Volume 171, Issue 15

Inclusive Pages



Community Health Services--utilization; Health Care Reform; Insurance Coverage--legislation & jurisprudence; Patient Preference; Poverty Areas; Safety Net; Community Health Centers; Health Reform


Background National health reform is designed to reducethe number of uninsured adults. Currently, many uninsured individualsreceive care at safety-net health care providers such as communityhealth centers (CHCs) or safety-net hospitals. This projectexamined data from Massachusetts to assess how the demand forambulatory and inpatient care and use changed for safety-netproviders after the state's health care reform law was enactedin 2006, which dramatically reduced the number of individualswithout health insurance coverage.

Methods Multiple methods were used, including analysesof administrative data reported by CHCs and hospitals, casestudy interviews, and analyses of data from the 2009 MassachusettsHealth Reform Survey, a state-representative telephone surveyof adults.

Results Between calendar years 2005 and 2009, the numberof patients receiving care at Massachusetts CHCs increased by31.0%, and the share of CHC patients who were uninsured fellfrom 35.5% to 19.9%. Nonemergency ambulatory care visits toclinics of safety-net hospitals grew twice as fast as visitsto non–safety-net hospitals from 2006 to 2009. The numberof inpatient admissions was comparable for safety-net and non–safety-nethospitals. Most safety-net patients reported that they usedthese facilities because they were convenient (79.3%) and affordable(73.8%); only 25.2% reported having had problems getting appointmentselsewhere.

Conclusions Despite the significant reduction in uninsurancelevels in Massachusetts that occurred with health care reform,the demand for care at safety-net facilities continues to rise.Most safety-net patients do not view these facilities as providersof last resort; rather, they prefer the types of care that areoffered there. It will continue to be important to support safety-netproviders, even after health care reform programs are established.

Peer Reviewed