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Health Aff (Millwood). 2008 Sep-Oct;27(5):w374-82. doi: 10.1377/hlthaff.27.5.w374. Epub 2008 Aug 12.

Caught in the competitive crossfire: safety-net providers balance margin and mission in a profit-driven health care market.

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  • 1Center for Studying Health System Change in Washington, DC, USA.


This paper describes how intensifying competitive pressures in the health system are simultaneously driving increased demand for safety-net care and taxing safety-net providers' ability to maintain the mission of serving all, regardless of ability to pay. Although safety-net providers adapted to previous challenges arising from managed care, health system pressures have been more intense and more generalized across different sectors in recent years than in the past. Providers are adopting some of the same strategies being used in the private sector to attract higher-paying patients and changing their "image" as a safety-net provider.

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