title: Recent trends and geographic variation in the safety net.
abstract: BACKGROUND
  Policymakers and researchers are concerned that changes in the healthcare market have stressed and weakened the safety net nationwide.
  
  
  OBJECTIVE
  The objectives of this study were to investigate variations in the safety net across communities and over time and to explore the effect of market changes on the safety net.
  
  
  METHODS
  We examined the safety net in all large urban communities from 1993 to 1998. Data from a variety of sources measure uncompensated hospital care, local government spending for health, admissions to safety net hospitals, visits to outpatient departments of safety net hospitals, visits to community health centers, and demographic and market characteristics of the communities. Descriptive analyses examine trends and community variations. Multivariate methods are used to estimate the effect of market structure and of economic factors on the safety net.
  
  
  RESULTS
  The safety net did not erode in urban areas over the study period. There was substantial variation across communities, but the disparity did not increase over time. HMO penetration and hospital competition are not significantly related to variations in the safety net, although demographic and economic factors are.
  
  
  CONCLUSIONS
  Local financing capacity is a factor in variations across communities in the safety net. The economic downturn and pressures on state budgets could lead to future problems.
authors.affiliation: RAND, Arlington, Virginia, USA. susanm@rand.org
authors.forename: M Susan
authors.initials: MS
authors.lastname: Marquis
authors.forename: Jeannette A
authors.initials: JA
authors.lastname: Rogowski
authors.forename: José J
authors.initials: JJ
authors.lastname: Escarce
mesh_terms: D018672:Community Health Planning / Q000458:organization & administration; D003695:Delivery of Health Care / Q000639:trends*; D006291:Health Policy; D006297:Health Services Accessibility; D006302:Health Services Research; D006779:Hospitals, Public / Q000458:organization & administration; D006801:Humans; D016014:Linear Models; D017057:Medically Uninsured; D017664:Uncompensated Care; D014481:United States; D014504:Urban Health