Dissertations, Theses and Capstone Projects

Date of Award

Fall 12-2010

Degree Type


Degree Name

Master of Public Administration (MPA)


Political Science


Nonprofit hospitals serve as part of the healthcare safety net to deliver a significant level of care to low-income, uninsured, underinsured, Medicaid and other vulnerable groups in society. Safety net hospitals are defined as those hospitals where at least 10 percent of the costs of care provided is uncompensated. Nonprofit hospitals are granted tax exemptions from the government and in exchange they are required to meet community benefit standards which include offering care to a relatively large proportion of uninsured or socially disadvantaged individuals.

Increasing poverty levels due to rising unemployment, foreclosures and economic distress have placed the safety net structure under tremendous stress. Policy makers are concerned whether the nonprofit hospitals are able to provide the level of community benefits to justify the forgone tax revenue estimated at $20 billion annually. The purpose of this study is to determine whether, in spite of the changing environment, nonprofit hospitals provide community benefits to low-income groups, and specifically to the Medicaid patients who visit their emergency departments.

The emergency department plays a critical role in the safety net of every community and extremely report high usage rates by Medicaid patients. Many of these patients often choose the emergency department as their primary source of care because of barriers they encounter in accessing healthcare.

A case study method was used to determine the visit rate levels of Medicaid patients to the emergency departments of both the Barrow Regional Medical Center and the Southern Regional Medical Center from 2004 to 2008. Both facilities are nonprofit hospitals in Barrow and Clayton counties, two counties whose poverty levels ranged from 11.3 to 14.7 percent. High poverty level rates are indicative of low-income households that are, in turn, confronted with many challenges, including access to healthcare. A similar analysis was conducted at the state level and the results reflected the findings at the county level, for instance visit rates were high for certain diseases.

It was established that emergency departments benefit the community by providing residents with crucial, on-demand healthcare services. The study concludes by recommending that in order to ensure the continued efficient and effective use of emergency departments, efforts should be made to reduce their use for non-emergent purposes through education, collaboration and other strategic interventions. Whether it serves as a first choice or last chance source of care, it is proven that the emergency departments provide a valuable and irreplaceable service for all community residents. It is not a tangible benefit but one that is highly valued.

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