HOSPITAL INDUSTRY RESTRUCTURING: IMPACT ON SAFETY NET

美国的医院业正在通过将医院合并为区域和地方卫生网络和系统而进行巨大的改造，到1996年，该行业的80%将在一个系统或网络中。 有一个信念，由一些案例研究支持，即管理式医疗服务系统的作用越来越大，特别是各州越来越多地使用医疗补助管理式医疗，导致私人和医疗补助患者从至少一些为医疗贫困者服务的医院转移，可能导致越来越多的财务破产，并可能导致这些医院的使命发生变化。 我们提议的研究将调查三个相互关联的问题，这些问题将共同揭示安全网医院在美国大都市统计区（MSAs）中不断变化的作用以及随后对患者群体的影响：研究问题1：安全网医院在什么情况下参与当地和区域卫生网络和系统以及何时被排除在外？如果被包括在内，它们参加了哪些类型的保健网络和系统？ 研究问题2：医疗补助管理的增长如何影响传统上依赖安全网的患者的护理模式，特别是未投保和医疗补助患者，以及安全网医院纳入（或排除）卫生系统和网络如何影响这些模式？ 研究问题3：纳入（或排除）卫生系统和网络如何影响安全网医院的成本、财务健康和生存？

The hospital industry in the United States is being dramatically reshaped through consolidation of hospitals into regional and local health networks and systems, with 80 percent of the industry in a system or network by 1996. There is a belief, supported by a number of case studies, that the increasing role of managed care delivery systems, and particularly the increasing use of Medicaid managed care by states, has led to a shift of private and Medicaid patients away from at least some hospitals serving the medically indigent, potentially leading to increasing financial insolvency and possibly to shifts in mission by these hospitals. Our proposed research study will investigate three interrelated questions that together will reveal the evolving role of safety net hospitals in metropolitan statistcs areas (MSAs) across the United States and the subsequent impact on patient populations: Research Question 1: Under what circumstances are safety net hospitals participating in local and regional health networks and systems and when are they excluded? When included, what types of health networks and systems do they participate in? Research Question 2: How has the growth of Medicaid managed care affected the patterns of care for patients who have traditionally relied on the safety net, specifically the uninsured and Medicaid patients, and how has safety net hospital inclusion in (or exclusion from) health systems and networks influenced these patterns? Research Question 3: How has the inclusion in (or exclusion from) health systems and networks affected the cost, financial health, and survival of safety net hospitals?