Threats to the health care safety net

The American health care safety net is threatened due to inadequate funding in the face of increasing demand for services by virtually every segment o f our society. The safety net is vital to public safety because it is the s ole provider for first-line emergency care, as well as for routine health c are of last resort, through hospital emergency departments (ED), emergency medical services providers (EMS), and public/free clinics. Despite the perc eived complexity, the causes and solutions for the current crisis reside in simple economics. During the last two decades health care funding has radi cally changed, yet the fundamental infrastructure of the safety net has cha nge little. In 1986, the Emergency Medical Treatment and Active Labor Act e stablished federally mandated safety net care that inadvertently encouraged reliance on hospital EDs as the principal safety net resource. At the same time, decreasing health care funding from both private and public sources resulted in declining availability of services necessary to support this sh ift in demand, including hospital inpatient beds, EDs, EMS providers, on-ca ll specialists, hospital-based nurses, and public hospitals/clinics. The re sult has been ED/hospital crowding and resource shortages that at times lim it the ability to provide even true emergency care and threaten the ability of the traditional safety net to protect public health and safety. This pa per explores the composition of the American health care safety net, the ro ot causes for its disintegration, and offers short- and long-term solutions . The solutions discussed include restructuring of disproportionate share f unding; presumed (deemed) eligibility for Medicaid eligibility; restructuri ng of funding for emergency care; health care for foreign nationals; the nu rsing shortage; utilization of a "health care resources commission"; "episo dic (periodic)" health care coverage; best practices and health care servic es coordination; and government and hospital providers' roles. Conclusions: There is a base amount of funding that must be available to the American h ealth care safety net to maintain its infrastructure and provide appropriat e growth, research, development, and expansion of services. Fall below this level and the infrastructure will eventually crumble. America must patch t he safety net with short-term funding and repair it with long-term health c are policy and environmental changes.