Suburban Poverty and the Health Care Safety Net

Communities Try to Improve Access for Suburban Poor

News Release
July 30, 2009

Alwyn Cassil (202) 264-3484 or

WASHINGTON, DC—As suburban poverty increases, the availability of health care services for low-income and uninsured people in the suburbs has not kept pace, according to a new study by the Center for Studying Health System Change (HSC) of five communities—Boston, Cleveland, Indianapolis, Miami and Seattle.

Previous research has shown that poverty rates in central city areas have followed national trends—declining during the 1990s but edging up since 2000—but poverty rates in suburban areas have increased steadily since 1990.

Low-income people living in suburban areas often have trouble accessing care because of inadequate transportation, language barriers and lack of awareness of health care options, and they often rely on suburban hospital emergency departments (EDs) and urban safety net hospitals and health centers, according to the HSC study funded by the Robert Wood Johnson Foundation.

"Both urban and suburban providers are trying to redirect patients to more appropriate care near where they live by expanding primary care capacity, improving access to specialists, reducing transportation challenges, and generating revenue to support safety net services," said Laurie E. Felland, M.S., an HSC senior health researcher and coauthor of the study with HSC Health Research Analyst Johanna R. Lauer and HSC Senior Fellow Peter J. Cunningham, Ph.D.

The study notes that "because suburban poverty is often dispersed, building a comprehensive system that stands apart from the urban safety net may not be practical or cost-effective in many suburbs, especially because low-income groups will continue to migrate to new areas. Instead, state and local governments and community groups could improve access to appropriate care by subsidizing services through existing providers; supporting more targeted and flexible approaches to providing services where people live, for example, through school-based clinics and mobile vans; and addressing transportation needs."

The study’s findings are detailed in a new HSC Research Brief—Suburban Poverty and the Health Care Safety Netavailable here. Between July and December 2008, a total of 60 interviews were conducted in the five communities with representatives of urban and suburban hospitals that play a safety net role, community health centers and clinics, local health departments, and other knowledgeable observers.

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The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.