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Atlantic Economic Journal

, Volume 37, Issue 3, pp 259–277 | Cite as

Hospital Financial Conditions and the Provision of Unprofitable Services

  • Hsueh-Fen ChenEmail author
  • Gloria J. Bazzoli
  • Hui-Min Hsieh
Article

Abstract

Increases in hospital financial pressure resulting from public and private payment policy may substantially reduce a hospital’s ability to provide certain services that are not well compensated or are frequently used by the uninsured. The objective of this study is to examine the impact of hospital financial condition on the provision of these unprofitable services for the insured and uninsured. Economic theory provides the conceptual underpinnings for the analysis, and a longitudinal empirical analysis is conducted for an eight-year study period. The results indicate that not-for-profit hospitals with strong financial performance provide more unprofitable services for the insured and uninsured than do not-for-profit hospitals with weaker condition. For-profit hospital provision of these services is not influenced by their financial condition and instead may reflect actions to meet community expectations or to offer a sufficiently broad service array to maintain the business of insured patients.

Keywords

Hospital financial condition Unprofitable services Insured patients Uninsured patients 

JEL

I00 

References

  1. Banks, D. A., Paterson, M., & Wendel, J. (1997). Uncompensated hospital care: Charitable mission or profitable business decision. Health Economics, 6, 133–143. doi: 10.1002/(SICI)1099-1050(199703)6:2<133::AID-HEC252>3.0.CO;2-X.CrossRefGoogle Scholar
  2. Bazzoli, G. J., Chen, H. F., Zhao, M., & Lindrooth, R. C. (2008). Hospital financial condition and quality of care. Health Economics, 17, 977–995. doi: 10.1002/hec.1311.CrossRefGoogle Scholar
  3. Bazzoli, G. J., Kang, R., Hasnain-Wynia, R., & Lindrooth, R. C. (2005). An update on safety-net hospitals: Coping with the late 1990s and early 2000s. Health Affairs, 24(4), 1047–1056. doi: 10.1377/hlthaff.24.4.1047.CrossRefGoogle Scholar
  4. Bazzoli, G. J., Lindrooth, R. C., Kang, R., & Hasnain-Wynia, R. (2006). The influence of health policy and market factors on the hospital safety net. Health Services Research, 41(4 Part 1), 1150–1180.Google Scholar
  5. Branas, C. C., MacKenzie, E. J., Williams, J. C., Schwab, C. W., Teter, H. M., Flanigan, M. C., et al. (2005). Access to trauma centers in the United States. Journal of the American Medical Association, 293(21), 2626–2633. doi: 10.1001/jama.293.21.2626.CrossRefGoogle Scholar
  6. Cunningham, P. J., Bazzoli, G. J., & Katz, A. (2008). Caught in the competitive crossfire: Safety-net providers balance margin and mission in a profit-driven health care market. Health Affairs-Web Exclusive, 27(5), w374–w382. doi: 10.1377/hlthaff.27.5.w374.CrossRefGoogle Scholar
  7. Davidoff, A., LoSasso, A. T., Bazzoli, G. J., & Zuckerman, S. M. (2000). The effects of changing state health policy on hospital uncompensated care. Inquiry, 37(3), 253–267.Google Scholar
  8. Department of Health and Human Services. (2005). Overview of the uninsured in the United States: An analysis of 2005 Current Population Survey. ASPE Issue Brief. http://aspe.hhs.gov/health/reports/05/uninsured-cps/ib.pdf. Accessed 2/22/09.
  9. Dranove, D., Shanley, M., & White, W. D. (1993). Price and concentration in hospital markets: The switch from patient-driven to payor-driven competition. The Journal of Law & Economics, 36(1 part 1), 179–204. doi: 10.1086/467270.CrossRefGoogle Scholar
  10. Encinosa, W. E., & Bernard, D. M. (2005). Hospital finances and patient safety outcomes. Inquiry, 42(1), 60–72.Google Scholar
  11. Foster, D. G., Klaisie, C., Blum, M., Bradsberry, M., Barindis, C. D., & Stewart, F. H. (2004). Extended state-funded family planning service: Estimating pregnancies averted by the family PACT program in California, 1997–1998. American Journal of Public Health, 94(8), 1341–1346. doi: 10.2105/AJPH.94.8.1341.CrossRefGoogle Scholar
  12. Gaskin, D. (1999). Safety net hospitals: Essential providers of public health and specialty services. New York: Commonwealth Fund.Google Scholar
  13. Gaskin, D. J., Hadley, J., & Freeman, V. G. (2001). Are urban safety-net hospitals losing low-risk Medicaid maternity patients? Health Services Research, 36(1), 25–51.Google Scholar
  14. Ginsburg, P. B., & Grossman, J. M. (2005). When the price isn’t right: How inadvertent payment incentives drive medical care. Health Affairs- Web Exclusive, 10, w5-376 -84.Google Scholar
  15. Hoerger, T. (1991). “Profit” variability in for-profit and not-for-profit hospitals. Journal of Health Economics, 10(3), 259–289. doi: 10.1016/0167-6296(91)90030-Q.CrossRefGoogle Scholar
  16. Horwitz, J. R. (2005). Making profits and providing care: Comparing nonprofit, for-profit, and government hospitals. Health Affairs, 24(3), 790–796. doi: 10.1377/hlthaff.24.3.790.CrossRefGoogle Scholar
  17. Kane, N. M., & Magnus, S. A. (2001). The Medicare Cost Report and the limits of hospital accountability: Improving financial data. Journal of Health Politics, Policy and Law, 26(1), 81–105. doi: 10.1215/03616878-26-1-81.CrossRefGoogle Scholar
  18. MacKenzie, E. J., Rivara, F. P., Jurkovich, G. J., Nathens, A. B., Frey, K. P., Egleston, B. L., et al. (2006). A national evaluation of the effect of trauma center care on mortality. New England Journal of Medicine, 354(4), 366–378. doi: 10.1056/NEJMsa052049.CrossRefGoogle Scholar
  19. Mark, B. A., Harless, D. W., & McCue, M. (2005). The impact of HMO penetration on the relationship between nurse staffing and quality. Health Economics, 14, 737–753. doi: 10.1002/hec.988.CrossRefGoogle Scholar
  20. Medicare Payment Advisory Commission (MedPAC). (2008). A data book: Healthcare spending and the Medicare program, June. Washington, DC. http://www.medpac.gov/documents/Jun08DataBook_Entire_report.pdf accessed 11/08/08.
  21. Newhouse, J. P. (1970). Toward a theory of nonprofit institutions: An economic model of a hospital. The American Economic Review, 60(1), 64–74.Google Scholar
  22. Nathens, A. B., Jurkovich, G. J., MacKenzie, E. J., & Rivara, F. P. (2004). A resource-based assessment of trauma care in the United States. Journal of Trauma, 56(1), 173–178. doi: 10.1097/01.TA.0000056159.65396.7C.CrossRefGoogle Scholar
  23. Schlesinger, M., & Gray, B. H. (2006). How nonprofits matter in American medicine, and what to do about it. Health Affairs, 25(4), w287–w303. doi: 10.1377/hlthaff.25.w287.CrossRefGoogle Scholar
  24. Weisbrod, B. A. (1980). Private goods, collective goods: The role of the nonprofit sector. In K. Clarkson & D. Martin (Eds.), The Economics of Nonpropriety Organizations, research in law and economics, Supplement 1 (pp. 139–177). Greenwich: JAI Press, Inc.Google Scholar
  25. Wooldridge, J. M. (2003). Introductory econometrics: A modern approach (2nd ed.). Mason, Ohio, South-Western.Google Scholar
  26. Zuckerman, S., Bazzoli, G. J., Davidoff, A., & LoSasso, A. (2001). How did safety-net hospitals cope in the 1990s? Health Affairs, 20(4), 159–167. doi: 10.1377/hlthaff.20.4.159.CrossRefGoogle Scholar

Copyright information

© International Atlantic Economic Society 2009

Authors and Affiliations

  • Hsueh-Fen Chen
    • 1
    Email author
  • Gloria J. Bazzoli
    • 2
  • Hui-Min Hsieh
    • 2
  1. 1.Department of Health Management and PolicyUniversity of North Texas Health Science CenterFort WorthUSA
  2. 2.Department of Health AdministrationVirginia Commonwealth UniversityRichmondUSA

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