The urban safety net: Can it keep people healthy and out of the hospital?

Thomas P. O'Toole, Jose Arbelaez, Christine Haggerty, N. J. Udochi, Maureen Beitman, William McClennan, Indira Kotval, Carol Miles, Lisa Knickmeyer, Meg Meyers, Deidre Thompson, Belinda Chen, Melva Jones, John Hickey

    Research output: Contribution to journalArticlepeer-review


    There is much discussion and debate over the relative vulnerability and capacity of the health care safety net to care for the growing numbers of uninsured and disenfranchised persons in urban poor communities. In this study, we present findings from a community-based survey of 248 adults identified at eight safety net provider sites in Baltimore, Maryland, to contextualize recent findings that described Baltimore's safety net capacity as having more hospital- and intensive service-based interventions, with higher proportions of the population reportedly unable to get care when needed compared with other cities. The average age of respondents was 41.2 years, most (87.3%) were African American, unemployed (75.8%), homeless (57.0%), and with at least one chronic medical problem (77.8%). Almost one half (47.6%) also reported a chronic mental health condition, and 51.2% reported having difficulty accessing health care services in the past. Overall, 76.9% reported accessing additional community sites for daily sustenance needs, with most of these sites community non-profit or faith-based organizations. In the multiple logistic regression model, only individuals with chronic mental health conditions were significantly more likely to report difficulties accessing health care. The lack of a Community Access Program or other structured efforts to facilitate integration of services among providers in Baltimore and an "all-payer" system that reimburses uncompensated care only for hospital admissions are postulated as two structural elements that may contribute to these findings.

    Original languageEnglish (US)
    Pages (from-to)179-190
    Number of pages12
    JournalJournal of Urban Health
    Issue number2
    StatePublished - Jun 2004


    • Health care access
    • Safety net
    • Uninsured
    • Urban poor

    ASJC Scopus subject areas

    • Public Health, Environmental and Occupational Health

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