More insured still strain safety-net hospitals

It's what the skeptics of the Affordable Care Act feared: Despite more insurance coverage under healthcare reform, patients may still be straining the health system. Safety-net hospitals, as well as community health centers, face overwhelming numbers of patients who seek safety nets because they are convenient and affordable, according to a new study published in the Archives of Internal Medicine.

The study found that patients in Massachusetts--the state credited for modeling national reform--increased the use of safety nets after near-universal coverage was implemented. Safety-net hospitals saw a 9.2 percent increase in nonemergent ambulatory care visits and a 1.8 percent increase in inpatient admissions between 2006 and 2009, according to a Los Angeles Times article.

"You might think that the newly insured would choose to go to the MGHs not the Boston Medical Centers, the private doctors in Back Bay, not the community health centers...but that is not what we found," said study author Dr. Leighton Ku of George Washington University in D.C., in a WBUR article.

Why did patients seek the comforts of a safety-net facility over a primary care physician? Patients cited reasons of convenience (79.3 percent), affordability (73.8 percent), and problems getting appointments elsewhere (25.2 percent).

"Massachusetts is an imported harbinger for the rest of the country, an advanced signal," Ku said. "[W]e need to remember that the safety-net system is important and brings services that the consumer wants."

However, Ku also said that the Massachusetts trend could differ in other states.

"The fact that people are still coming to them doesn't mean that will be the case everywhere. If they [the hospitals] are not offering good services and making patients happy, once people have insurance, they might walk away."

Despite the strain on safety nets, another report last month found that healthcare reform is working in the state in terms of patient outcomes. The National Bureau of Economic Research found that access to Medicaid substantially increased healthcare use and patient well-being, as well as reduced the financial strain of covered individuals.

For more information:
- read the study abstract
- read the WBUR article
- see the LA Times article