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NAPH annual survey shows increasingly important role of safety net hospitals

June 7, 2012

WASHINGTON—National Association of Public Hospital and Health System (NAPH) members—the backbone of the nation’s health care safety net—represent 2 percent of the nation’s acute care hospitals but delivered 20 percent of uncompensated care by U.S. hospitals in 2010, new NAPH data show.

NAPH’s annual member characteristics report, America’s Safety Net Hospitals and Health Systems, 2010, found that NAPH members delivered increasing levels of outpatient and inpatient services and that uninsured patients accounted for 30 percent of ambulatory care visits and 19 percent of inpatient services.

“Our members serve large patient volumes and many of the nation’s most vulnerable citizens, often with limited resources,” NAPH President and CEO Bruce Siegel, MD, MPH, said. “Yet, even with these challenges, NAPH members maintain high levels of quality through innovative practices.”

But, he cautioned, the careful balance NAPH members have achieved providing quality care with constrained resources could be upset by policy changes that further erode federal and state funding for hospitals that provide a disproportionate share of uncompensated care. “We must not lessen our commitment to safety net providers or assume their ability to do more with less means additional cuts won’t harm care.”

The 52-page report was developed by the National Public Health and Hospital Institute (NAPH’s research affiliate) based on an annual NAPH member survey. It underscores the importance of Medicaid disproportionate share hospital (DSH) payments and other government support to safety net hospitals. The average margin for NAPH hospitals was 2.3 percent in 2010 compared with 7.2 percent for all hospitals nationwide. Without Medicaid DSH, the report noted, NAPH member hospitals would have suffered a 6.1 percent loss. Without DSH and other supplemental Medicaid payments, the loss would have increased to 10.6 percent.

In other survey findings for 2010:

  • On average, NAPH members reported almost three times the volume of inpatient admissions seen in other acute care hospitals and exceeded average admissions within their markets by 44 percent.
  • NAPH members provided nearly $128 billion in total inpatient and outpatient services, nearly half of which was for low-income patients.
  • NAPH members trained more than 19,000 full-time equivalent (FTE) medical and dental residents and more than 300 FTE allied health professionals.
  • Of NAPH member costs, 16 percent were uncompensated, compared with 6 percent of costs for hospitals nationally.
  • NAPH members represented 37 percent of the level 1 trauma care and 57 percent of the burn care beds in the 10 largest U.S. cities. In 31 communities nationwide, NAPH members are either the only level 1 trauma center or the only trauma center of any level.

The full report and an executive summary are available as complimentary downloads at The report provides data on other areas of safety net hospital expertise, including community health services and emergency preparedness.

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About the National Association of Public Hospitals and Health Systems (NAPH)
NAPH represents the nation’s safety net hospitals and health systems, which provide high volumes of care to low-income individuals. These facilities offer high-quality health services for all patients, including the uninsured and underinsured, regardless of ability to pay. In addition to helping ensure access to health care for all Americans, safety net hospitals provide many essential communitywide services, such as primary care, trauma care, and neonatal intensive care. Safety net hospitals also train many of America’s doctors, nurses, and other health care providers. Since its inception in 1980, NAPH has cultivated a strong presence on Capitol Hill, with the executive branch, and in many state capitols. NAPH advocates on behalf of its members on such issues as Medicaid, Medicare, and access to health care services for vulnerable populations. For more information, visit our website at

Media Contact:
Carl Graziano
(202) 585-0102


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