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. ? ? ?
