Safety-net providers: is co-payment the way forward?

Safety-net providers: is co-payment the way forward?


Recent research from Gallup shows the number of uninsured patients in the U.S. is at a record low – at 11 percent. While this should be welcomed, statistics show that 23 million patients will still be without insurance by 2019. For these patients, safety-net clinics are one of the few healthcare providers they can turn to. However, these clinics can often struggle for funding themselves, and with the changing face of healthcare, they need to look for ways to remain financially viable. Could co-payments from patients be part of the solution?

The benefits and significance of co-payment

Co-payment has the potential to provide benefits to both the safety-net provider and the patients themselves, especially as safety-net clinics face uncertain times ahead. Patients would feel like they were contributing to their care by paying a nominal fee, rather than seeking ‘charity’. When patients pay towards their own care it can be beneficial to their self-esteem by improving a patient’s sense of self-sufficiency – and patients are happy to contribute where they can.

A contribution from patients would also help them to appreciate the value of health and wellness. In addition, it prepares them for when it becomes time to transition to commercial medical insurance, where they will face health insurance premiums and co-payments.

Challenging times for the safety-net community

The introduction of the Affordable Care Act has led to changing times for the safety-net community. As a Kaiser Family Foundation report states

“The ACA presents opportunities, challenges and uncertainties for safety net hospitals and health care systems.  Coverage expansions under the ACA via premium tax credits for moderate-income individuals and through Medicaid in states adopting the ACA Medicaid expansion provide a major opportunity for safety net systems to gain new reimbursement for patients who previously were uninsured.

At the same time, safety-net providers face challenges and uncertainties due to competition for newly insured patients, low Medicaid reimbursement, and federal reductions in supplemental payments to hospitals for uncompensated care through Medicare and Medicaid DSH payments.”

Safety-net clinics need to evolve to keep up with these changing and challenging times in healthcare and introducing co-payment arrangements for patients is one option. However, this is a move that many in the safety-net community would be reluctant to make; most of the patients visiting these clinics are already vulnerable and on low incomes. The introduction of co-payments could lead to additional disparity for patients who already face significant barriers to healthcare.


With millions of Americans uninsured, there is a huge strain placed on the limited resources of safety-net clinics. The safety-net community is likely to be under pressure to change direction and reform to meet the demands of an evolving healthcare system, and this is going to leave safety-net clinics with some tough decisions to make. Co-payment is indeed an option, but it is a choice that could lead to further disparity for the users of such services. As always,  Free and Charitable Clinics may charge a nominal/sliding fee to patients, and still be considered Free or Charitable Clinics provided essential services are delivered regardless of the patient’s ability to pay.  Any copayments assessed by the clinic may be waived according to clinic policy, generally on a sliding-fee scale basis or for extenuating circumstances.

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