Patient demand for care from safety-net providers (such as community health centers and public hospitals) in Massachusetts has increased, even though the number of patients with health insurance also increased following the state’s passage of health care reform, according to a report in JAMA’s Archives of Internal Medicine.
Major expansion of health insurance as part of federal health reform will occur by 2014, providing coverage to millions of individuals who currently lack it, but still leaving an estimated 24 million without insurance. The report may help to dispel conventional wisdom that demand for safety-net services would decrease once individuals obtain insurance coverage.
“Of the various health care providers, safety-net providers will be the most affected by the health coverage expansion because they are the major providers of care for the uninsured,” writes Mitchell Katz, M.D., in an accompanying editorial. “The important lesson from Massachusetts is that the newly insured continued to seek care in the safety net.”
This scenario may differ in other parts of the country, depending on perceived quality and convenience of safety-net providers and the degree of competition from other providers. “How much competition there will be for the newly insured is unknown,” points out Katz.
As federal health reform is implemented, the health care system will likely have to:
- Increase capacity to care for newly insured patients.
- Develop teams of health care providers rather than train more primary care physicians.
- Structure facilities that are more convenient and affordable.
“Most safety-net patients do not view these facilities as providers of last resort; rather, they prefer the types of care that are offered there,” the authors write. “It will continue to be important to support safety-net providers, even after health care reform programs are established.”
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