Monitoring the Healthcare Safety Net

Book 1. Data for Metropolitan Areas

Table A-1: Safety Net Measures in this Data Book, their Definitions, and Data Sources

Contents

Demand for Safety Net Services
Financial Support for Safety Net Services

Structure of the Safety Net—Inpatient Care
Structure of the Safety Net—Concentration and Distribution of Inpatient Uncompensated Care and Medicaid Discharges
Structure of the Safety Net—Ambulatory Care

Health Care Delivery System

Community Context—Population
Community Context—Race/Ethnicity
Community Context— Indices of Racial and Economic Separation
Community Context—Immigrant Population
Community Context—Economy
Community Context—Living Arrangements, Housing, Education, and Crime

Access-Related Outcome Measures—Preventable/Avoidable Hospitalizations (Ambulatory Care Sensitive Conditions)
Access-Related Outcome Measures—Births
Access-Related Outcome Measures—Survey-Based Reported Barriers to Access

Demand for Safety Net Services

Measure Definition Data Source(s) Methodological Notes
% Uninsured
Percent of the population under age 65 that is uninsured Number of uninsured individuals under age 65 divided by the total population under age 65. 1999–2001 Current Population Survey–3-year average Data available only at state and large MSA level because of CPS sample size limits.
Percent of the population under age 65 with family incomes below 200 percent of the Federal poverty line that is uninsured Number of individuals under age 65 with family incomes less than 200 percent of the Federal poverty line who are uninsured, divided by the number of individuals under age 65 with family incomes less than 200 percent of the Federal poverty line. 1999– 2001 Current Population Survey– 3- year average Data available only at state and large MSA level because of CPS sample size limits.
% Below Poverty
Percent of the population with incomes below 100 percent of the Federal poverty line Number of individuals with family incomes less than 100 percent of the Federal poverty line, divided by the total population for whom poverty status is reported. U.S. Census 2000 Federal poverty level determinations are not adjusted for differences in cost of living among areas.
Percent of the population ages 0–17 with incomes below 100 percent of the Federal poverty line Number of individuals ages 0– 17 with family incomes less than 100 percent of the Federal poverty line, divided by the total population ages 0– 17 for whom poverty status is reported. U.S. Census 2000 Federal poverty level determinations are not adjusted for differences in cost of living among areas.
Percent of the population ages 18–64 with incomes below 100 percent of the Federal poverty line Number of individuals ages 18–64 with family incomes less than 100 percent of the Federal poverty line, divided by the total population ages 18– 64 for whom poverty status is reported. U.S. Census 2000 Federal poverty level determinations are not adjusted for differences in cost of living among areas.
Percent of population age 65 and older with family incomes below 100 percent of Federal poverty line Number of individuals age 65 and older with family incomes less than 100 percent of the Federal poverty line, divided by the total population age 65 and older for whom poverty status is reported. U.S. Census 2000 Federal poverty level determinations are not adjusted for differences in cost of living among areas.
% With a Disability
Percent of the population ages 5–20 who have a disability Number of individuals ages 5– 20 reporting a disability, divided by the number of civilian non- institutionalized individuals ages 5– 20 for whom disability status is reported. U.S. Census 2000 People 5 years old and over are considered to have a disability if they have one or more of the following: (a) blindness, deafness, or a severe vision or hearing impairment; (b) a substantial limitation in the ability to perform basic physical activities, such as walking, climbing stairs, reaching, lifting, or carrying; (c) difficulty learning, remembering, or concentrating; or (d) difficulty dressing, bathing, or getting around inside the home. In addition to the above criteria, people 16 years old and over are considered to have a disability if they have difficulty going outside the home alone to shop or visit a doctor's office, and people 16– 64 years old are considered to have a disability if they have difficulty working at a job or business.
Percent of the population ages 21–64 who have a disability Number of individuals ages 21– 64 reporting a disability, divided by the number of civilian non- institutionalized individuals ages 21– 64 for whom disability status is reported. U.S. Census 2000 People 5 years old and over are considered to have a disability if they have one or more of the following: (a) blindness, deafness, or a severe vision or hearing impairment; (b) a substantial limitation in the ability to perform basic physical activities, such as walking, climbing stairs, reaching, lifting, or carrying; (c) difficulty learning, remembering, or concentrating; or (d) difficulty dressing, bathing, or getting around inside the home. In addition to the above criteria, people 16 years old and over are considered to have a disability if they have difficulty going outside the home alone to shop or visit a doctor's office, and people 16– 64 years old are considered to have a disability if they have difficulty working at a job or business.
Percent of the population age 65 and older who have a disability Number of individuals age 65 and older reporting a disability, divided by the number of civilian non-institutionalized individuals age 65 and older for whom disability status is reported. U.S. Census 2000 People 5 years old and over are considered to have a disability if they have one or more of the following: (a) blindness, deafness, or a severe vision or hearing impairment; (b) a substantial limitation in the ability to perform basic physical activities, such as walking, climbing stairs, reaching, lifting, or carrying; (c) difficulty learning, remembering, or concentrating; or (d) difficulty dressing, bathing, or getting around inside the home. In addition to the above criteria, people 16 years old and over are considered to have a disability if they have difficulty going outside the home alone to shop or visit a doctor's office, and people 16– 64 years old are considered to have a disability if they have difficulty working at a job or business.
AIDS Cases per 100,000
AIDS prevalence per 100,000 population Cumulative number of individuals with AIDS reported to the Centers for Disease Control and Prevention, divided by the total population, multiplied by 100,000 (available at the MSA level only). Numerator from data maintained by the Centers for Disease Control and Prevention; Denominator from 2001 Claritas (1999 interpolated estimate)  

Return to Contents

Financial Support for Safety Net Services

Measure Definition Data Source(s) Methodological Notes
Medicaid Program
Extent of Medicaid coverage State-level standardized index of income eligibility levels for the Medicaid program for pregnant women, children, and infants. UCLA Center for Health Policy Research  
Percent of the population under age 65 with family incomes below 200 percent of the Federal poverty line that is enrolled in Medicaid Number of individuals under age 65 with family incomes less than 200 percent of the Federal poverty line who are enrolled in Medicaid, divided by the number of individuals under age 65 with family incomes less than 200 percent of the Federal poverty line. 1999–2001 Current Population Survey–3-year average Data available only at state and large MSA level because of CPS sample size limits.
Medicaid expenditures per person under age 65 with family incomes below 200 percent of the Federal poverty line (excludes long- term care expenditures) Total State and Federal Medicaid expenditures for services other than long- term care, divided by the number of individuals under age 65 with family incomes less than 200 percent of the Federal poverty line. Numerator: Centers for Medicare and Medicaid Services–HCFA-2082 Reports; Denominator: 1999–2001 Current Population Survey–3- year average Data available only at state and large MSA level because of CPS sample size limits.
DSH Funds ($) per Person Below Poverty
Medicare Disproportionate Share Hospital payments per person with family incomes less than 100 percent of the Federal poverty line Total Medicare Disproportionate Share Hospital payments to hospitals, divided by the number of individuals with family incomes less than 100 percent of the Federal poverty line. Numerator: Centers for Medicare and Medicaid Services; Denominator: U. S. Census 2000 Medicaid DSH payments were not readily available at the local level.
CHC in Area
Presence of a Community Health Center Presence or absence of a federally funded Community Health Center in the area. Health Resources and Services Administration– Uniform Data System Data Note: Community health centers serve many areas reaching beyond county boundaries— these data indicate presence/ absence of community health center located in the county.
Uncompensated Care Pooling
Uncompensated care pooling Presence or absence of an uncompensated care pool in the state. An uncompensated care pool helps finance hospital- based care for uninsured patients by providing financial support to hospitals and other providers to help defray the expenses of uncompensated care. Local governments and State hospital associations  

Return to Contents

Structure of the Safety Net—Inpatient Care

Measure Definition Data Source(s) Methodological Notes
Admissions by Hospital Ownership Type
Hospital admissions by ownership type: Percent in public facilities Number of admissions to public hospitals, divided by the total number of admissions to all area hospitals (limited to non-Federal general medical/surgical facilities). 1999 American Hospital Association Annual Survey Figures are based on location of the hospital (not patient origin which may be from other counties).
Hospital admissions by ownership type: Percent in not-for-profit facilities Number of admissions to not-for-profit hospitals, divided by the total number of admissions to all area hospitals (limited to non- Federal general medical/surgical facilities). 1999 American Hospital Association Annual Survey Figures are based on location of the hospital (not patient origin which may be from other counties).
Hospital admissions by ownership type: Percent in investor-owned facilities Number of admissions to investor-owned hospitals, divided by the total number of admissions to all area hospitals (limited to non-Federal general medical/surgical facilities). 1999 American Hospital Association Annual Survey Figures are based on location of the hospital (not patient origin which may be from other counties).
Admissions by Teaching Status
Hospital admissions by teaching status: Percent "no teaching" Number of admissions to hospitals with no medical residents, divided by the total number of admissions to all area hospitals (limited to non- Federal general medical/ surgical facilities). 1999 American Hospital Association Annual Survey Figures are based on location of the hospital (not patient origin which may be from other counties).
Hospital admissions by teaching status: Percent "low teaching" Number of admissions to hospitals with 1 to 4 medical residents per 100 staffed beds, divided by the total number of admissions to all area hospitals (limited to non-Federal general medical/surgical facilities). 1999 American Hospital Association Annual Survey Figures are based on location of the hospital (not patient origin which may be from other counties).
Hospital admissions by teaching status: Percent "moderate teaching" Number of admissions to hospitals with 5 to 14 medical residents per 100 staffed beds, divided by the total number of admissions to all area hospitals (limited to non-Federal general medical/surgical facilities). 1999 American Hospital Association Annual Survey Figures are based on location of the hospital (not patient origin which may be from other counties).
Hospital admissions by teaching status: Percent "major teaching" Number of admissions to hospitals with 15 or more medical residents per 100 staffed beds, divided by the total number of admissions to all area hospitals (limited to non- Federal general medical/surgical facilities). 1999 American Hospital Association Annual Survey Figures are based on location of the hospital (not patient origin which may be from other counties).

Return to Contents

Structure of the Safety Net—Concentration and Distribution of Inpatient Uncompensated Care and Medicaid Discharges

Measure Definition Data Source(s) Methodological Notes
Uncompensated and Medicaid Discharges
Uncompensated and Medicaid discharges: Index of market concentration An index that indicates the extent to which the market share of uncompensated care and Medicaid patients is concentrated in a small number of hospitals, with a higher value indicating greater concentration. ("Herfindahl Index") Patient discharge data– 1999 HCUP and other sources  
Uncompensated and Medicaid discharges: Cost shifting index Percent on average that area hospitals must raise charges to commercial patients to make up for the revenue lost through the provision of uncompensated care (Percent on average that area hospitals must raise commercial charges to "cost shift" uncompensated care). Patient discharge data– 1999 HCUP and other sources  
Uncompensated and Medicaid discharges: Gini coefficient Percent of area patients who would have to change hospitals to equalize uncompensated care and Medicaid discharges across all area hospitals. Patient discharge data– 1999 HCUP and other sources  
Uncompensated and Medicaid discharges: Percent of discharges from high-burden hospitals Percent of patients in hospitals with a cost shifting index greater than or equal to 0.25. Patient discharge data– 1999 HCUP and other sources  

Return to Contents

Structure of the Safety Net—Ambulatory Care

Measure Definition Data Source(s) Methodological Notes
Outpatient Visits per Admission
Outpatient department visits per admission Number of visits to outpatient departments of area hospitals divided by number of admissions to area hospitals. 1999 American Hospital Association Annual Survey Figures are based on location of the hospital (not patient origin which may be from other counties).
CAP Grant
Presence of Community Access Program (CAP) grant Presence or absence of a Community Access Program (CAP) grant from the Health Resources and Services Administration. The CAP grants build on existing models of service integration to help health care providers develop integrated, community-wide systems that serve the uninsured and underinsured. Health Resources and Services Administration Data available at the MSA level only since the "service area" of many CAP programs evolves over time and often includes multiple counties.
Contents of Data Books
Contents of Table A-1: Safety Net Measures in this Data Book, their Definitions, and Data Sources
Proceed to Next Section