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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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  • Almond, Douglas
  • Currie, Janet
  • Simeonova, Emilia

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 to 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. The results in this paper suggest, perhaps surprisingly, that requiring private providers to serve the underinsured can be effective.

Suggested Citation

  • Almond, Douglas & Currie, Janet & Simeonova, Emilia, 2011. "Public vs. private provision of charity care? Evidence from the expiration of Hill-Burton requirements in Florida," Journal of Health Economics, Elsevier, vol. 30(1), pages 189-199, January.
  • Handle: RePEc:eee:jhecon:v:30:y:2011:i:1:p:189-199
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    1. Currie, Janet & Gruber, Jonathan & Fischer, Michael, 1995. "Physician Payments and Infant Mortality: Evidence from Medicaid Fee Policy," American Economic Review, American Economic Association, vol. 85(2), pages 106-111, May.
    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. Glied, Sherry & Zivin, Joshua Graff, 2002. "How do doctors behave when some (but not all) of their patients are in managed care?," Journal of Health Economics, Elsevier, vol. 21(2), pages 337-353, March.
    4. Gruber, Jon & Kim, John & Mayzlin, Dina, 1999. "Physician fees and procedure intensity: the case of cesarean delivery," Journal of Health Economics, Elsevier, vol. 18(4), pages 473-490, August.
    5. Mark G. Duggan, 2000. "Hospital Ownership and Public Medical Spending," The Quarterly Journal of Economics, Oxford University Press, vol. 115(4), pages 1343-1373.
    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, 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. 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.
    2. Jensen, Vibeke Myrup & Wüst, Miriam, 2015. "Can Caesarean section improve child and maternal health? The case of breech babies," Journal of Health Economics, Elsevier, vol. 39(C), pages 289-302.
    3. Hiroaki Matsuura, 2014. "Does the Constitutional Right to Health Matter? A Review of Current Evidence," ifo DICE Report, ifo Institute - Leibniz Institute for Economic Research at the University of Munich, vol. 12(2), pages 35-41, 07.
    4. repec:ces:ifodic:v:12:y:2014:i:2:p:19116213 is not listed on IDEAS
    5. Cory Capps & Dennis W. Carlton & Guy David, 2017. "Antitrust Treatment of Nonprofits: Should Hospitals Receive Special Care?," NBER Working Papers 23131, National Bureau of Economic Research, Inc.
    6. Rossin-Slater, Maya, 2013. "WIC in your neighborhood: New evidence on the impacts of geographic access to clinics," Journal of Public Economics, Elsevier, vol. 102(C), pages 51-69.

    More about this item

    Keywords

    Infant health Charity care Cesarean section Prematurity Hill-Burton;

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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