Impact of Closure of a Safety Net HIV Case Management Agency
| Author | Carl Latkin,Peter Winch,Caitlin Kennedy,Nidhi Khosla,Jill Marsteller |
| DOI | http://doi.org/10.1002/wmh3.139 |
| Published date | 01 June 2015 |
| Date | 01 June 2015 |
Impact of Closure of a Safety Net HIV Case
Management Agency
Nidhi Khosla, Caitlin Kennedy, Peter Winch, Carl Latkin, and Jill Marsteller
Safety net healthcare agencies serve important roles within organizational networks, yet little
research has examined the impact of their closure on other healthcare organizations. Using a case
study approach, we explored the impact of the sudden closure of a prominent safety net HIV agency
on other HIV service organizations and clients in a U.S. city. We conducted 23 key informant
interviews and examined newspaper articles and agency publications. The agency’s closure led to
many clients being lost to the system, delays in care, and the loss of a caring community asset that
provided unique services together (e.g., legal aid, showers, laundry, lockers for homeless people).
Other organizations suffered since they had relied on the agency for case management services.
Agencies should engage in transition planning and sustainability planning to ensure continuity of
services. Policymakers must implement health system changes in a planned manner wherever
possible.
KEY WORDS: HIV service organizations, safety net agencies, health facility closure, network theory,
vulnerable populations, collaboration, community health centers, organizational interdependence
Introduction
Safety net agencies include entities such as health centers; public and charity
hospitals; and not-for-profit agencies that serve vulnerable populations such as
low income patients, the underinsured, and the uninsured. The Institute of
Medicine (IOM) defines the safety net as “Those providers that organize and
deliver a significant level of health care and other health-related services to
uninsured, Medicaid, and other vulnerable patients” (Institute of Medicine, 2000).
Services provided by them include primary care, mental health, dental care, and
substance abuse services (Shi et al., 2013). Safety net health-care agencies can play
a very important role in reducing health disparities by providing care to the
underinsured and the uninsured (Shi et al., 2013). For instance, 2010 Health
Resources and Services Administration (HRSA) data showed that health centers’
(a type of safety net agency) patients’ profile included about 93 percent persons
with incomes below 200 percent of the federal poverty level, 62 percent racial or
ethnic minorities, and about 38 percent uninsured (Shi et al., 2013).
World Medical & Health Policy, Vol. 7, No. 2, 2015
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Literature Review
Literature on the effects of closure of safety net health-care agencies has
focused mostly on the impact on health-care access and health status among
former clients (Bindman, Keane, & Lurie, 1990; Buchmueller, Jacobson, & Wold,
2006; Liu, Hader, Brossart, White, & Lewis, 2001; Reif, DesHarnais, & Bernard,
1999; Walker et al., 2011b). These studies have found negative effects of agency
closure, such as reduced availability of local medical services and increased travel
time to medical facilities, leading to deterioration in clients’ health status. Fewer
studies (e.g., Browne & Braun, 2001; Romero, Kwan, Swearingen, Nestler, &
Cohen, 2012) have discussed other effects (e.g., emotional loss) of agency closure
on clients and caregivers. Similarly, less is known about the impact of health-care
agencies’ closure on other health-care providers such as physicians (Walker,
Clarke, Ryan, & Brown, 2011a) and other health-care agencies (Adalja, Watson,
Wollner, Rambhia, & Toner, 2011).
Rationale for the Study
In this paper, we investigate the perspectives of HIV agencies about the
impact of the sudden closure of a prominent safety net HIV case management
agency that served poor and vulnerable populations including the homeless. This
agency was a not-for-profit agency, also known as a nongovernmental organiza-
tion (NGO). The agency was located in a mid-sized city on the East Coast of the
United States. In this paper, we refer to the agency using an alias: HIV/AIDS
Care Agency, abbreviated as “HACA.” Studying the closure of this agency is
important because it played a major role in the network of HIV agencies in the
city and other agencies depended on it for guidance, client referrals, and case
management, among other functions. It developed case management standards
for the city and served other agencies by acting as an entry point to the HIV care
system and by linking clients to services.
Literature on NGO participation in networks suggests that NGOs join
networks in order to gain visibility, access to resources, and improve quality of
their services (Ostergaard and Nielsen, n.d.). Networks may be formal or informal
(Ostergaard and Nielsen, n.d.). Many agencies may informally participate in
activities with other agencies, also called networking (Ostergaard and Nielsen,
n.d.). Networking may be especially important among agencies that serve people
living with HIV, as these individuals often have multiple needs (e.g., housing,
medical, spiritual, legal). HIV agencies typically specialize in particular services
and depend on other agencies to serve those needs of their clients that cannot be
served in-house. A network analysis of connections among HACA and other HIV
agencies regarding functions such as client referrals, information exchange, and
joint programs published in 2001 showed that HACA’s centrality scores were
among the highest in the network (citation withheld to protect HACA’s
confidentiality). The higher the centrality scores, the more central is the agency
(important role is played by the agency in the network). Therefore, we anticipated
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