Fiscal Shenanigans, Targeted Federal Health Care Funds, and Patient Mortality
The federal government spends billions of dollars each year on programs designed to increase the resources available to hospitals that serve the poor. This paper explores the intended and unintended effects of such targeted funds. First, how do these funds distort the behavior of state and local governments who wish to appropriate the funds for other uses? Second, to the extent that these funds do increase resources in the targeted hospitals, do patients benefit? We use the rapid and uneven growth in Medicaid Disproportionate Share Hospital (DSH) payments across states and hospitals to answer these questions. We identify states that were most able to appropriate DSH funds and show that, while DSH payments to public hospitals in these states were systematically diverted, DSH payments to other hospitals and in other states were not diverted. Additional resources that were made available to hospitals (rather than appropriated by the state) were associated with significant declines in infant and post-heart attack mortality. A range of evidence suggests that these improvements were due to better hospital care. Overall, our analysis implies that public subsidies can be an effective mechanism for improving medical care and outcomes for the poor, but that the impact is limited by the ability of state and local government to divert the targeted funds.
|Date of creation:||Apr 2004|
|Publication status:||published as Baicker, Katherine and Douglas Staiger. "Fiscal Shenanigans, Targeted Federal Health Care Funds, And Patient Mortality," Quarterly Journal of Economics, 2005, v120(1,Feb), 345-386.|
|Contact details of provider:|| Postal: National Bureau of Economic Research, 1050 Massachusetts Avenue Cambridge, MA 02138, U.S.A.|
Web page: http://www.nber.org
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- Kominski, Gerald F. & Long, Stephen H., 1997. "Medicare's disproportionate share adjustment and the cost of low-income patients," Journal of Health Economics, Elsevier, vol. 16(2), pages 177-190, April.
- Hope Corman & Theodore Joyce & Michael Grossman, 1987. "A Cost-Effectiveness Analysis of Strategies to Reduce Infant Mortality," NBER Working Papers 2346, National Bureau of Economic Research, Inc.
- Janet Currie & Jonathan Gruber, 1997. "The Technology of Birth: Health Insurance, Medical Interventions, and Infant Health," NBER Working Papers 5985, National Bureau of Economic Research, Inc.
- David M. Cutler & Ellen Meara, 2000.
"The Technology of Birth: Is It Worth It?,"
NBER Chapters,in: Frontiers in Health Policy Research, Volume 3, pages 33-68
National Bureau of Economic Research, Inc.
- David M. Cutler & Ellen Meara, 1999. "The Technology of Birth: Is it Worth it?," NBER Working Papers 7390, National Bureau of Economic Research, Inc.
- Mark G. Duggan, 2000. "Hospital Ownership and Public Medical Spending," The Quarterly Journal of Economics, Oxford University Press, vol. 115(4), pages 1343-1373.
- Mark Duggan, 2000. "Hospital Ownership and Public Medical Spending," NBER Working Papers 7789, National Bureau of Economic Research, Inc.
- Currie, Janet & Gruber, Jonathan, 1996. "Saving Babies: The Efficacy and Cost of Recent Changes in the Medicaid Eligibility of Pregnant Women," Journal of Political Economy, University of Chicago Press, vol. 104(6), pages 1263-1296, December.
- Cutler David M. & Meara Ellen, 2000. "The Technology of Birth: Is It Worth It?," Forum for Health Economics & Policy, De Gruyter, vol. 3(1), pages 1-37, January.
- Nicholson, Sean & Song, David, 2001. "The incentive effects of the Medicare indirect medical education policy," Journal of Health Economics, Elsevier, vol. 20(6), pages 909-933, November. Full references (including those not matched with items on IDEAS)