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Public vs. Private Provision of Charity Care? Evidence from the Expiration of Hill-Burton Requirements in Florida

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  • Douglas Almond
  • Janet Currie
  • Emilia Simeonova

Abstract

This paper explores the consequences of the expiration of charity care requirements imposed on private hospitals by the Hill-Burton Act. We examine delivery care and the health of newborns using the universe of Florida births from 1989-2003 combined with hospital data from the American Hospital Association. We find that charity care requirements were binding on hospitals, but that private hospitals under obligation “cream skimmed” the least risky maternity patients. Conditional on patient characteristics, they provided less intensive maternity services but without compromising patient health. When obligations expired, private hospitals quickly reduced their charity caseloads, shifting maternity patients to public hospitals. There they received more intensive services, but did not experience improvements in health. These results suggest that public hospitals provided services less efficiently than private hospitals constrained to provide charity care.

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Bibliographic Info

Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 15798.

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Date of creation: Mar 2010
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Publication status: published as Almond, Douglas, Janet Currie and Emilia Simeonova. "Public vs. Private Provision of Charity Care? Evidence from Hill-Burton Hospitals in Florida" Journal of Health Economics, Vol 30, Issue 1, pp 189-199, 2011.
Handle: RePEc:nbr:nberwo:15798

Note: CH HC HE PE
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  1. Mark G. Duggan, 2000. "Hospital Ownership And Public Medical Spending," The Quarterly Journal of Economics, MIT Press, MIT Press, vol. 115(4), pages 1343-1373, November.
  2. Chernew, Michael & Keenan, Patricia & Cutler, David, 2005. "Charity Care, Risk Pooling, and the Decline in Private Health Insurance," Scholarly Articles 2640562, Harvard University Department of Economics.
  3. Janet Currie & Jonathan Gruber & Michael Fischer, 1994. "Physician Payments and Infant Mortality: Evidence from Medicaid Fee Policy," NBER Working Papers 4930, National Bureau of Economic Research, Inc.
  4. Gruber, Jon & Kim, John & Mayzlin, Dina, 1999. "Physician fees and procedure intensity: the case of cesarean delivery," Journal of Health Economics, Elsevier, Elsevier, vol. 18(4), pages 473-490, August.
  5. Sherry Glied & Joshua Zivin, 2000. "How Do Doctors Behave When Some (But Not All) of Their Patients are in Managed Care?," NBER Working Papers 7907, National Bureau of Economic Research, Inc.
  6. Michael Chernew & David Cutler & Patricia Seliger Keenan, 2005. "Charity Care, Risk Pooling, and the Decline in Private Health Insurance," American Economic Review, American Economic Association, American Economic Association, vol. 95(2), pages 209-213, May.
  7. Edward C. Norton & Douglas O. Staiger, 1994. "How Hospital Ownership Affects Access to Care for the Uninsured," RAND Journal of Economics, The RAND Corporation, vol. 25(1), pages 171-185, Spring.
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Cited by:
  1. Rossin-Slater, Maya, 2013. "WIC in your neighborhood: New evidence on the impacts of geographic access to clinics," Journal of Public Economics, Elsevier, Elsevier, vol. 102(C), pages 51-69.
  2. Bacci, Silvia & Bartolucci, Francesco & Pieroni, Luca, 2012. "A causal analysis of mother’s education on birth inequalities," MPRA Paper 38754, University Library of Munich, Germany.
  3. Hiroaki Matsuura, 2014. "Does the Constitutional Right to Health Matter? A Review of Current Evidence," CESifo DICE Report, Ifo Institute for Economic Research at the University of Munich, Ifo Institute for Economic Research at the University of Munich, vol. 12(2), pages 35-41, 07.

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