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Health Affairs Commentary Argues for Essential Hospital Designation

A new Health Affairs Forefront commentary by top member leaders of America’s Essential Hospitals makes a strong case for federal designation of essential hospitals to ensure they receive the support they need to meet their safety net mission.

“Given the vital role essential hospitals play … it is imperative that these institutions can successfully meet and sustain their mission to fulfill community needs while advancing health equity for all people,” write Eric Dickson, MD, MHCM, Steve Purves, and Charlie Shields, MBA, the association’s current, immediate past, and incoming board chairs, respectively. “Current and future public health and public policy initiatives must recognize and easily identify this class of providers to maintain their sustainability.”

The commentary appeared Oct. 3 on Forefront, Health Affairs’ health policy news, commentary, and analysis website. The member leaders say essential hospitals’ indispensable role, unique characteristics, and financial fragility argue for recognizing them as a distinct class in public health and policymaking. They point to ample precedent for such a designation, such as special recognition for critical access hospitals and federally qualified health centers.

To define essential hospitals, policymakers should consider patient demographics and breadth of services, as well as payer mix; existing metrics; commitment to mission; and state-level variations in policies and populations, the authors say. They argue against financial metrics, which can fail to account for core aspects of essential hospitals’ mission and patients and can be subject to anomalies and fluctuations in public policies, payments, and other variables.

The commentary points out that the Institute of Medicine, in a 2000 report, called for a targeted federal initiative to support the nation’s health care safety net due to concerns about its ongoing viability. “The case for sustaining the safety net, including essential hospitals, is as strong today as it was in 2000,” the association leaders conclude.


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