Public vs. private provision of charity care? Evidence from the expiration of Hill-Burton requirements in Florida

Douglas Almond, Janet Currie, Emilia Simeonova

Research output: Contribution to journalArticle

4 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)189-199
Number of pages11
JournalJournal of Health Economics
Volume30
Issue number1
DOIs
StatePublished - Jan 2011

All Science Journal Classification (ASJC) codes

  • Health Policy
  • Public Health, Environmental and Occupational Health

Keywords

  • Cesarean section
  • Charity care
  • Hill-Burton
  • Infant health
  • Prematurity

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