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In 2000, in its landmark report on the health care safety net, The Institute of Medicine identified two defining characteristics of “core” safety net providers: (1) the organization had a legal mandate or explicitly adopted mission to offer patients access to services regardless of their ability to pay; and (2) a substantial share of the provider's patients were uninsured, covered by Medicaid, or members of other vulnerable populations. See Lewin, M. and Altman, S., eds., America's Health Care Safety Net: Intact but Endangered (Washington, D.C.: National Academy Press, 2000). In practice, safety net hospitals are defined in the health services research literature in different ways, including the hospital's proportion of uninsured and/or Medicaid patients, amount of uncompensated care, and various facility or market characteristics. For additional information on ways to define safety net hospitals, see M. McHugh, R. Kang, and R. Hasnain-Wynia, “Understanding the Safety Net: Inpatient Quality of Care Varies Based on How One Defines Safety-Net Hospitals,” Medical Care Research and Review 66, no. 5 (2009): 590-605.Google Scholar

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