Hospitals, Managed Care, and the Charity Caseload in California
Many observers have blamed HMOs for increasing financial pressures on private hospitals and causing them to cut back on the provision of charity care. We examine this issue using data on all hospital discharges in California between 1988 and 1996. We find that public hospitals in counties with higher HMO penetration do take on a larger share of the county's charity caseload. However, these public hospitals also take on larger shares of most other types of patients. At the hospital level, we find little evidence that either for-profit or non-profit private hospitals respond to HMO penetration by turning away uninsured and Medicaid patients. On the contrary, in the for-profit sector higher HMO penetration is linked to reductions in the share of privately insured patients in the caseload, and corresponding increases in the share of Medicare patients and Medicaid births. Since HMO penetration reduces the price paid by privately insured patients they may be less attractive to for-profit hospitals relative to the publicly insured.
|Date of creation:||Dec 2001|
|Date of revision:|
|Publication status:||published as Currie, Janet & Fahr, John, 2004. "Hospitals, managed care, and the charity caseload in California," Journal of Health Economics, Elsevier, vol. 23(3), pages 421-442, May.|
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- Noether, Monica, 1988. "Competition among hospitals," Journal of Health Economics, Elsevier, vol. 7(3), pages 259-284, September.
- Janet Currie & Aaron S. Yelowitz, 1999.
"Health Insurance and Less Skilled Workers,"
JCPR Working Papers
63, Northwestern University/University of Chicago Joint Center for Poverty Research.
- Mark G. Duggan, 2000.
"Hospital Ownership And Public Medical Spending,"
The Quarterly Journal of Economics,
MIT Press, vol. 115(4), pages 1343-1373, November.
- Hilary Williamson Hoynes, 2000.
"Local Labor Markets And Welfare Spells: Do Demand Conditions Matter?,"
The Review of Economics and Statistics,
MIT Press, vol. 82(3), pages 351-368, August.
- Hilary Williamson Hoynes, 1996. "Local Labor Markets and Welfare Spells: Do Demand Conditions Matter?," NBER Working Papers 5643, National Bureau of Economic Research, Inc.
- H. W. Hoynes, . "Local Labor Markets and Welfare Spells: Do Demand Conditions Matter?," Institute for Research on Poverty Discussion Papers 1104-96, University of Wisconsin Institute for Research on Poverty.
- Thorpe, Kenneth E & Phelps, Charles E, 1991. "The Social Role of Not-for-Profit Organizations: Hospital Provision of Charity Care," Economic Inquiry, Western Economic Association International, vol. 29(3), pages 472-84, July.
- Jason R. Barro & David Cutler, 1997.
"Consolidation in the Medical Care Marketplace: A Case Study from Masschusetts,"
NBER Working Papers
5957, National Bureau of Economic Research, Inc.
- Jason Barro & David M. Cutler, 2000. "Consolidation in the Medical Care Marketplace,A Case Study from Massachusetts," NBER Chapters, in: Mergers and Productivity, pages 9-50 National Bureau of Economic Research, Inc.
- Richard G. Frank & David S. Salkever, 1991. "The Supply of Charity Services by Nonprofit Hospitals: Motives and Market Structure," RAND Journal of Economics, The RAND Corporation, vol. 22(3), pages 430-445, Autumn.
- David M. Cutler & Louise Sheiner, 1998.
"Managed Care and the Growth of Medical Expenditures,"
in: Frontiers in Health Policy Research, Volume 1, pages 77-116
National Bureau of Economic Research, Inc.
- David M. Cutler & Louise Sheiner, 1997. "Managed Care and the Growth of Medical Expenditures," NBER Working Papers 6140, National Bureau of Economic Research, Inc.
- David M. Cutler & Jonathan Gruber, 1995.
"Does Public Insurance Crowd Out Private Insurance?,"
NBER Working Papers
5082, National Bureau of Economic Research, Inc.
- Cutler, David M & Gruber, Jonathan, 1996. "Does Public Insurance Crowd Out Private Insurance?," The Quarterly Journal of Economics, MIT Press, vol. 111(2), pages 391-430, May.
- Pauly, Mark V, 1987. "Nonprofit Firms in Medical Markets," American Economic Review, American Economic Association, vol. 77(2), pages 257-62, May.
- 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.
- Laurence C. Baker, 1995. "HMOs and Fee-For-Service Health Care Expenditures: Evidence from Medicare," NBER Working Papers 5360, National Bureau of Economic Research, Inc.
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