Division of Hospital Medicine, Emory University School of Medicine, Atlanta, CA 30322, USA.
Int J Health Serv. 2013;43(2):321-35. doi: 10.2190/HS.43.2.h.
Massachusetts health care reform, designed to expand coverage and access to care for vulnerable populations, serves as the model for national health reform in the United States that will be implemented in 2014. Yet, little is known about how the reform may have affected the demand for and the financial performance of safety net hospitals (SNH), the primary source of care for such populations before the reform. Using a quasi-experimental design that included all acute care hospitals in the state, we calculated changes in mean inpatient and outpatient volumes, revenue, and operating margins at SNH from the pre-reform (Fiscal Year 2006) to the post-reform (Fiscal Year 2009) period. We contrasted these changes with contemporaneous changes occurring among non-safety net hospitals (NSNH) using a difference-in-differences approach. We found that SNH in Massachusetts continue to play a disproportionately large role in caring for disadvantaged patients after reform, but that their financial performance has declined considerably compared with NSNH. Ongoing reform efforts in the United States should account for continued SNH demand among the most vulnerable patients and should be designed so as not to undermine the financial stability of SNH that meet this demand.
马萨诸塞州的医疗改革旨在扩大弱势群体的医疗保障和可及性，为 2014 年美国国家医疗改革提供了模式。然而，对于改革可能如何影响安全网医院（SNH）的需求和财务表现，人们知之甚少，SNH 是改革前此类人群的主要医疗服务提供方。我们采用准实验设计，包括该州所有的急性护理医院，计算了 SNH 在改革前（2006 财年）到改革后（2009 财年）期间住院和门诊量、收入和运营利润率的平均变化。我们使用差异中的差异方法，将这些变化与同期非安全网医院（NSNH）的变化进行对比。我们发现，马萨诸塞州的 SNH 在改革后继续在照顾弱势患者方面发挥着不成比例的重要作用，但与 NSNH 相比，它们的财务表现已经大幅下降。美国正在进行的改革努力应该考虑到最脆弱患者对 SNH 的持续需求，并应确保这些需求不会破坏 SNH 的财务稳定。
