Systematic Review Of US Health Care Safety-Net Definitions

The health care safety net is critical to the care of patients with complex clinical and social needs. However, it is not uniformly defined across clinical settings, which may misdirect policies and funding. We performed a systematic review of peer-reviewed literature on safety-net definitions across the care continuum between March 2024 and March 2026. Our search produced 3,462 unique articles, with 2,532 articles ultimately included in the review. Safety-net definitions were categorized into a non-mutually exclusive framework that identified definitions based on population, institution, area, or other characteristics. Most included articles defined safety net according to population-level (89.1 percent) and institution-level (66.8 percent) characteristics, whereas others defined it by additional characteristics (5.5 percent area level and 42.2 percent other level). A data-driven assessment of definitions identified patients' insurance and socioeconomic status, as well as public ownership and funding sources, socioeconomic deprivation indices, and safety-net affiliate sites, as concepts used to refer to the US health care safety net. This systematic review produced an exhaustive collection of safety-net definitions within a framework for categorizing those definitions that may help policy makers better understand and support the US health care safety net.