Safety Net Hospitals; A Resource for the Healthcare Consumers

Safety Net Hospitals; A Resource for the Healthcare Consumers

There are up to 5 Million Healthcare Consumers uninsured in the United States.  In addition, there are up to 31 million Healthcare Consumers that are underinsured.

What are the definitions of uninsured and underinsured?

Uninsured is defined as a consumer without any healthcare insurance.

Underinsured is defined as a consumer that has healthcare insurance with very high deductibles and large amounts out of pocket expenses compared to their income.

What are the potential health consequences for being uninsured or underinsured?

         Skipping needed healthcare

          Delaying needed medical services

          Skipping needed medication

          Your medical problems become worse

          Spending current income and savings on current and previous incurred healthcare                 expenses

The healthcare consumer needs to know what is a Safety Net Hospital and how they work. More importantly, how Safety Net Hospitals can improve healthcare of consumers.

A safety net hospital or health system provides a significant level of care to low-income, uninsured, and vulnerable populations as defined by the Essential Hospitals Association.  Safety net hospitals are further distinguished by their commitment to provide access to care for people with limited or no access to healthcare due to their financial circumstances, insurance issues or health conditions.  Three characteristics distinguish Safety Net Hospitals:

  1. By legal mandate or directed to maintain a mission of open doors for patients regardless of their ability to pay
  2. The patient payor mix is substantially uninsured, Medicaid and other vulnerable patients
  3. Publicly owned hospitals

Safety Net Hospitals are generally in urban settings (66%); 34% in rural areas.  Safety net hospitals depend on public subsidies like Medicare and Medicaid Disproportionate Share Hospital (DSH) payments, as well as on state and local tax appropriations, for revenues to help finance their important missions. There are three different ownership types; publicly owned, nonprofit owned and for profit owned.  Ownership may drive how accessible a Safety Net Hospital maybe.  The following are observations based on a consumers ability to pay:

Publicly Owned:  Treats consumers regardless of ability to pay.

Non-Profit Owned:  Will be more aggressive regarding consumers’ ability to pay, may require advance payment prior to service and may deny services for elective medical services.

For Profit Owned:  Could be even more aggressive than Non-Profit Owned Hospitals.

Safety Net Hospitals are known primarily for the care of uninsured consumers.   They also provide public health and specialty services—such as trauma, emergency psychiatric, and burn care—that benefit the entire community.

The healthcare consumer should determine:

  1. Which hospitals in your community are publicly owned. The following is a list of the 50 largest public hospitals in the United States.  Many of the hospitals are in urban areas and do not reflect rural public hospitals.  The consumer can go the internet and enter” Public Hospital either by state or city” and search.
  2. Safety Net Hospitals provide not only basic healthcare services but many specialty services. Following the list of public hospitals is a listing of services provided by safety net hospitals.
  3. Public Hospitals are less restrictive than Non-profit or For Profit hospitals. This means the consumer has greater access to medical services.
  4. Public Hospitals are generally affiliated with a Medical School. Medical School affiliations are very good.
  5. If the healthcare consumer needs medical service and has no other access to medical care, Public Hospitals are the answer.

Top 50 Public Hospitals In the U.S.

1.Jackson Memorial Hospital (Miami) — 1,724 beds
2. Erie County Medical Center (Buffalo, N.Y.) — 1,137 beds
3. UAB Hospital (Birmingham, Ala.) — 1,097 beds
4. Bergen Regional Medical Center (Paramus, N.J.) — 1,004 beds
5. Memorial Regional Hospital (Hollywood, Fla.) — 993 beds
6. Ohio State University Hospital (Columbus) — 951 beds
7. Grady Memorial Hospital (Atlanta) — 933 beds
8. Lee Memorial Hospital (Fort Myers, Fla.) — 931 beds
9. University of Michigan Hospitals and Health Centers (Ann Arbor) — 915 beds
10. Bellevue Hospital Center (New York City) — 912 beds
11. Carolinas Medical Center (Charlotte, N.C.) — 866 beds
12. Greenville (S.C.) Memorial Hospital — 831 beds
13. Huntsville (Ala.) Hospital — 811 beds
14. Laguna Honda Hospital (San Francisco) — 805 beds
15. Sarasota (Fla.) Memorial Hospital — 786 beds
16. University of North Carolina Hospitals (Chapel Hill) — 774 beds
17. Parkland Hospital (Dallas) — 764 beds
18. MetroHealth Medical Center (Cleveland) — 737 beds
19. Los Angeles County + University of Southern California Medical Center (Los Angeles) — 724 beds
20. VCU Medical Center (Richmond, Va.) — 719 beds
21. Central Virginia Training Center (Madison Heights) — 718 beds
22. Medical University of South Carolina-University Hospital (Charleston) — 696 beds
23. University of Iowa Hospital & Clinics (Iowa City) — 687 beds
24. New Hanover Regional Medical Center (Wilmington, N.C.) — 679 beds
25. University of California San Francisco Medical Center at Parnassus (San Francisco) — 660 beds
26. Westchester Medical Center (Valhalla, N.Y.) — 643 beds
27. Broward Health Medical Center (Fort Lauderdale, Fla.) — 640 beds
28. Medical Center of Central Georgia (Macon, Ga.) — 639 beds
29. Kings County Hospital Center (Brooklyn, N.Y.) — 634 beds
30. Jackson-Madison County General Hospital (Jackson, Tenn.) — 633 beds
31. University of Mississippi Medical Center (Jackson) — 610 beds
32. Maricopa Medical Center (Phoenix) — 592 beds
33. Ben Taub General Hospital (Houston) — 586 beds
34. Kaweah Delta Hospital (Vasalia, Calif.) — 581 beds
35. Gwinnett Medical Center-Lawrenceville (Ga.) — 576 beds
36. John Peter Smith Hospital (Fort Worth, Texas) — 576 beds
37. The University of Kansas Hospital (Kansas City) — 576 beds
38. Stony Brook (N.Y.) University Medical Center — 572 beds
39.  Wellstar Kennestone Hospital (Marietta, Ga.) — 572 beds
40. Monroe Community Hospital (Rochester, N.Y.) — 571 beds
41. The University of Texas MD Anderson Cancer Center (Houston) — 571 beds
42. University Medical Center (Las Vegas) — 564 beds
43. University of California Davis Medical Center (Sacramento, Calif.) — 563 beds
44. Santa Clara Valley Medical Center (San Jose, Calif.) — 554 beds
45. Cape Fear Valley Medical Center (Fayetteville, N.C.) — 552 beds
46. Medical Center of Daytona Beach (Fla.) — 550 beds
47. University of New Mexico Hospital (Albuquerque) — 546 beds
48. Elmhurst (N.Y.) Hospital Center — 545 beds
49. Erlanger Baroness (Chattanooga, Tenn.) — 538 beds
50. Sharp Grossmont Hospital (La Mesa, Calif.) — 536 beds

Services Provided By Safety Net Hospitals

Burn care

Pediatric intensive care

Neonatal intensive care unit

Trauma care

Psychiatric care

Alcoholism treatment

Psychiatric outpatient services

Obstetric care

AIDS services

Crisis prevention

Other special care

Psychiatric emergency services


Freestanding outpatient center


Coronary intensive care unit

Social services

Emergency room services

Community outreach

Health screening

Hospice care


How does it work when the consumer arrives at a Safety Net Hospital?  The following is a general process most Safety Net Hospitals use.

Are you eligible for assistance at a Safety Net Hospital?

To find out, ask to talk to a Patient Advocate.  The Patient Advocate will have the information, forms, and process for you to follow. The facility will ask you to provide them with certain documentation.  This is critical for them to determine your eligibility.  Many consumers do not comply with this requirement.  Be aware that you may qualify for partial assistance.

If I have Healthcare Insurance, can I qualify for assistance?

In general, yes.  This can be a complicated situation that will require research and discussions by the consumer with the Patient Advocate to determine eligibility requirements.

If I qualify, do I have to apply every time I go to the hospital?

In general no, but ask the hospital Patient Advocate.

What income guide lines do Safety Net Hospitals use?

 Most use the most current Federal Poverty Guidelines.

Do Immigrants qualify?

In general, yes, but ask the hospital Patient Advocate.

If I am turned down for assistance, can I appeal?

In general, yes, but ask the Hospital Patient Advocate.


Most communities have Safety Net Hospitals.  Remember…. Safety Net Hospitals have different ownership models the can dictate access to medical care.  The following is a list by name of the facilities.

Alameda Health System (Oakland, Calif.)

Arrowhead Regional Medical Center (Colton, Calif.)
Banner Health (Tucson, Ariz.)

Bon Secours Baltimore Health System (Baltimore)
Boston Medical Center (Boston)
Broadlawns Medical Center (Des Moines, Iowa)
Broward Health (Fort Lauderdale, Fla.)

Cambridge Health Alliance (Cambridge, Mass.)

Care New England Health System (Providence, R.I.)

CaroMont Health (Gastonia, N.C.)
City and County of San Francisco Department of Public Health (San Francisco)

Contra Costa Health Services (Martinez, Calif.)

Cook County Health & Hospitals System (Chicago)

DCH Regional Health System (Tuscaloosa, Ala.)

Denver Health Medical Center (Denver)

East Alabama Medical Center (Opelika, Ala.)

Einstein Healthcare Network (Philadelphia)

Erie County Medical Center (Buffalo, N.Y.)
Erlanger Health System (Chattanooga, Tenn.)

Grady Health System (Atlanta)

Halifax Health (Daytona Beach, Fla.)

Harris Health System (Houston)

Health and Hospital Corporation of Marion County (Indianapolis)

Health Care District of Palm Beach County (Palm Springs, Fla.)

Hennepin County Medical Center (Minneapolis, Minn.)
Henry Ford Health System (Detroit)

Hurley Medical Center (Flint, Mich.)
Jackson Health System (Miami)

JPS Health Network (Fort Worth, Texas)

KentuckyOne Health (Louisville, Ky.)

Kern Medical (Bakersfield, Calif.)
Lee Health (Fort Myers, Fla.)

Los Angeles County Department of Health Services (Los Angeles)

Maricopa Integrated Health System (MIHS) (Phoenix)

Medical University of South Carolina (Charleston, S.C.)
Memorial Health (Savannah, Ga.)
Memorial Healthcare System (Hollywood, Fla.)

Methodist Health System (Dallas)
Methodist Hospitals (Gary and Merrillville, Ind.)
Nashville General Hospital at Meharry (Nashville, Tenn.)
Natividad Medical Center (Salinas, Calif.)
Navicent Health (Macon, Ga.)
Nebraska Medicine (Omaha, Neb.)
Norwegian American Hospital (Chicago)
NuHealth (East Meadow, N.Y.)
NYC Health + Hospitals (New York)

Orlando Health (Orlando, Fla.)

Parkland Health & Hospital System (Dallas)
Regional One Health (Memphis, Tenn.)
Regions Hospital (St. Paul, Minn.)
Rhode Island Hospital (Providence, R.I.)

Riverside County Regional Medical Center (Moreno Valley, Calif.)
RWJBarnabas Health (Jersey City, N.J.)

San Joaquin General Hospital (French Camp, Calif.)
San Mateo Medical Center (San Mateo, Calif.)
Santa Clara Valley Health & Hospital System (San Jose, Calif.)

Signature Healthcare Brockton Hospital (Brockton, Mass.)
Spartanburg Regional Healthcare System (Spartanburg, S.C.)

St. Joseph’s Regional Medical Center (Paterson, N.J.)

St. Luke’s Health System (Boise, Idaho)

SUNY-State University of New York (Albany, N.Y.)

Swedish Covenant Hospital (Chicago)
Tampa General Hospital (Tampa, Fla.)
Temple University Health System (Philadelphia)

The MetroHealth System (Cleveland)

The Ohio State University Wexner Medical Center (Columbus, Ohio)

The University of Chicago Medicine (Chicago)

The University of Kansas Hospital (Kansas City, Kan.)
The University of Mississippi Health Care (Jackson, Miss.)

The University of Texas Medical Branch (Galveston, Texas)

Truman Medical Centers (Kansas City, Mo.)

UC Health (Cincinnati)

UK HealthCare (Lexington, Ky.)

UMass Memorial Health Care (Worcester, Mass.)

United Medical Center (Washington, DC)
University Health (Shreveport, La.)
University Health System (San Antonio)

University Hospital (Newark , N.J.)
University Medical Center of El Paso (El Paso, Texas)
University Medical Center of Southern Nevada (Las Vegas)

University Medical Center New Orleans (New Orleans)
University of Alabama at Birmingham (UAB Health System) (Birmingham, Ala.)

University of Arkansas for Medical Sciences (UAMS) (Little Rock, Ark.)
University of California (Los Angeles)

University of Florida Health (Gainesville, Fla.)

University of Illinois Hospital & Health Sciences System (Chicago)
University of Missouri Health Care (Columbia, Mo.)

University of South Alabama Medical Center (Mobile, Ala.)

University of Tennessee Medical Center (Knoxville, Tenn.)
University of Utah Health Care (Salt Lake City)

University of Vermont (UVM) Medical Center (Burlington, Vt.)

University of Virginia Health (Charlottesville, Va.)

UNM Health Sciences Center (Albuquerque, N.M.)

UT Health Northeast (Tyler, Texas)
UW Medicine (Seattle)

VCU Health (Richmond, Va.)

Ventura County Health Care Agency (Ventura, Calif.)

WVU Medicine (Morgantown, W. Va.)

Westchester Medical Center (Valhalla, N.Y.)

Yuma Regional Medical Center (Yuma, Ariz.)


In summary, Safety Net Hospitals are a healthcare resource consumers can leverage if necessary.  Not making healthcare treatment decisions can cause major healthcare problems for consumers as outlined above.  The Commonwealth Fund in 2014 conducted a survey to fully understand the problems experienced by underinsured consumers.  The following are a portion of the results.

51% has problems paying medical bills

44% received a lower credit rating

47% used all their savings

34% used their credit cards to pay

9% used a second mortgage

7% declared bankruptcy

Sadly, healthcare consumers do not understand what options are available.  Most of the above events could have been avoided if the healthcare consumer took advantage of Safety Net Hospitals.



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