Safety Net Hospitals and Minority Access to Health Care

安全网医院和少数族裔获得医疗保健的机会

基本信息

批准号：
7597125
负责人：
GLORIA J BAZZOLI
金额：
$ 35.52万
依托单位：
VIRGINIA COMMONWEALTH UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-05-01 至 2011-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7597125
关键词：
Accident and Emergency department Accounting Acculturation Address Affect American Hospital Association Area Behavior Budgets Burn Units Caring Case Study Characteristics Communities Community Hospitals Commuting County Data Development Emergency Care Event Exhibits Federal Government Financial Support Geographic Distribution Geographic Locations Growth Health Health Personnel Health Services Health Services Accessibility Health Services Research Health Status Health system Healthcare Hospital Closures Hospital safety Hospitals Indigent Indigent Care Individual Industry Institute of Medicine (U.S.)Institution Institutional Policy Insurance Coverage Intervention Legal Life Link Low income Masks Measures Medicaid Medical Education Medically Underserved Area Medicare Minority Minority Groups Mission Nature Neighborhoods Neonatal Intensive Care Units Outcome Ownership Patients Pattern Persons Play Policies Policy Maker Population Population Group Primary Health Care Principal Investigator Private Hospitals Procedures Public Health Public Hospitals Public Policy Relative (related person)Research Research Personnel Resources Role Services Social isolation Socioeconomic Factors Source Substance abuse problem Time Transportation Travel Uninsured United States United States National Institutes of Health Variant Visit Vulnerable Populations Work cost electric impedance ethnic minority population health care service organization health disparity medical specialties minority health novel strategies payment pressure programs racial and ethnic racial and ethnic disparities residence safety net segregation socioeconomics

项目摘要

DESCRIPTION (provided by applicant): Safety net hospitals play a critical role in the US health system providing access to health services for vulnerable populations, especially low-income racial and ethnic minorities. However, these hospitals have faced increasing strain over the last decade due to public and private payment pressures, growing demand for indigent care, and the growing concentration of this care in fewer institutions. Given this, the closure or ownership conversion of even a few safety net hospitals could have major effects on communities whose residents depend on these institutions. Although several studies have examined the hospital safety net and others have examined health disparities among racial and ethnic minority groups, little research has linked these two areas. The National Institute of Health's PA-05-006 identified this research as a priority because institutional policies, such as hospital closure or conversion, could affect the accessible supply of racial and ethnic minority health care providers and thus exacerbate racial and ethnic disparities in access to care, health status, and outcomes. Our proposed analysis examines how patterns of access are affected by safety net hospital contraction, examining its effects on minority and non-minority individuals living in low- income areas. We develop multiple measures of accessibility, accounting for a variety of place-specific factors not typically used in health services research, such as a multivariate factor reflecting physical/geographical impedance and measures of acculturation and residential segregation. We use these accessibility measures to identify communities with the greatest access impediments following safety net hosptial closure or conversion. We then undertake case study research to assess which groups of individuals, as distinguished by socioeconomic factors, were most affected when access to safety net resources declined in their communities and what policy interventions may have limited or exacerbated these detrimental effects. Our research is important given continued budget problems in several states and the federal govemement. In relation to the latter, 2005 legislative action reduced Medicaid spending by $10 billion between 2007 and 2010 and the 2007 Bush Administration budget application called for an additional $35 billion cut over a ten- year period. Such large reductions in Medicaid support could push more safety net hospitals to close or convert ownership. It is important for policy makers, the public, and the health industry to know what this might mean for access to care if the loss of financial support results in further safety net contraction.

描述（由申请人提供）：安全网医院在美国卫生系统中发挥着关键作用，为弱势群体，特别是低收入种族和少数民族提供卫生服务。然而，在过去十年中，由于公共和私人支付压力、对贫困护理的需求不断增长以及这种护理日益集中在较少的机构中，这些医院面临着越来越大的压力。鉴于此，即使是少数安全网医院的关闭或所有权转换也可能对居民依赖这些机构的社区产生重大影响。尽管有几项研究考察了医院安全网，其他研究也考察了种族和少数族裔群体之间的健康差异，但很少有研究将这两个领域联系起来。美国国立卫生研究院的 PA-05-006 将该研究确定为优先事项，因为医院关闭或转院等制度政策可能会影响少数族裔和少数族裔医疗保健提供者的可获得性，从而加剧获得医疗服务方面的种族和族裔差异。护理、健康状况和结果。我们提出的分析研究了安全网医院收缩如何影响就诊模式，并研究其对生活在低收入地区的少数族裔和非少数族裔个人的影响。我们制定了多种可及性衡量标准，考虑了卫生服务研究中通常不使用的各种特定地点因素，例如反映物理/地理阻抗的多元因素以及文化适应和居住隔离的衡量标准。我们利用这些无障碍措施来确定安全网医院关闭或改建后无障碍程度最大的社区。然后，我们进行案例研究，以评估哪些群体（按社会经济因素区分）在其社区获得安全网资源的机会减少时受到的影响最大，以及哪些政策干预措施可能会限制或加剧这些有害影响。鉴于几个州和联邦政府持续存在的预算问题，我们的研究非常重要。就后者而言，2005 年的立法行动将 2007 年至 2010 年间的医疗补助支出减少了 100 亿美元，而 2007 年布什政府的预算申请则要求在 10 年内再削减 350 亿美元。医疗补助支持的大幅减少可能会促使更多安全网医院关闭或转换所有权。对于政策制定者、公众和卫生行业来说，重要的是要知道，如果失去财政支持导致安全网进一步收缩，这对获得医疗服务可能意味着什么。