This meeting brought together four speakers with varied perspectives on offering safety net services to the uninsured and underinsured and to those experiencing problems in gaining access to health care services. The discussion focused on the types of patients who use safety net providers and the reasons they turn to the safety net. Special pressures currently faced by the safety net were also identified, among them the size of the uninsured population, the competition among providers for patients with insurance coverage, and the growth of managed care together with the reduced ability of safety net providers to cross-subsidize care of indigent patients. Speakers examined the gaps in the safety net, such as the difficulty in obtaining specialty referrals for their patients and in securing care for those with chronic illnesses. Federal, state, and local roles in safety net policy were also explored.
Raymond Baxter, PhD., Executive Vice President, Lewin Group; Susan E. Nestor Levy, Senior Vice President for Advocacy and External Relations, Ascension Health, St. Louis, Missouri; John G. O'Brien, Chief Executive Officer, Cambridge Health Alliance, and Commissioner of Health, Cambridge, Massachusetts; Mario F. Pacheco, MD, Robert Wood Johnson Foundation Fellow, Office of Sen. Jeff Bingaman