Challenges and strategies in serving the uninsured in Nashville, Tennessee

This study identified challenges faced by a healthcare safety net system. Surveys of safety net outpatient clinic and hospital emergency department (ED) facilities and key informant interviews ascertained barriers to providing necessary client services and strategies to overcome them. About 60% of key informants responded that Medicaid cuts greatly increased the numbers of uninsured clients. The outpatient clinic and ED personnel reported that the capacity of providers to care for these increasing numbers of uninsured was primarily strained by limited referral resources for needed specialty care. The most commonly cited successful coping strategies for clinics were networking and partnering. [corrected].