Publications by Stuart Guterman for Health Policy Center

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These reports are based on detailed case studies of safety net hospitals in Los Angeles, Houston, Boston, Detroit and Denver. Our analysis suggests that the future viability of hospitals to serve the uninsured is related to the availability of explicit or implicit financial support from local, state and federal sources and the magnitude of the uninsurance problem the facility is trying to solve. We did not find that the trend toward Medicaid managed care was an insurmountable problem for safety net hospitals. In fact, we found that the relative financial health of safety net hospitals in Denver and Boston was directly related to the aggressive approach they took toward establishing their own managed care plans. Nevertheless, despite the current financial status of individual facilities, there was widespread concern about the future. Published by the Kaiser Commission on the Medicaid and the Uninsured; 2001 April. Available at www.kff.org.

With spending totaling more than $15 billion a year, one of the largest public subsidy programs to help pay for health care services for the uninsured is the Medicaid disproportionate share hospital (DSH) program. Although the DSH program sometimes has been highly controversial, this study provides some insights on the experiences of five community programs that have used DSH funds in a positive way: To provide health care services to the uninsured. While each program is unique and faces it own set of circumstances, several lessons are drawn to guide other communities as they search for local solutions to the growing problem of caring for the uninsured.

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