Essays On U.S. Health Policy And Hospital Care
My dissertation consists of three chapters, each of which empirically examines impacts of U.S. health care policies on hospital care for a subgroup of disadvantaged populations. The first chapter studies the impacts of Medicaid coverage expansions for pregnant women on patient reallocation across hospitals. If patients from low-income zip codes, who are likely to gain coverage after expanded public insurance coverage, have limited hospital options due to a lack of payer source, they may be able to receive care at higher quality hospitals once they obtain coverage. Using Florida hospital data and the Nationwide Inpatient Sample (NIS) for 1988-1995, I find that low-income mothers who gained coverage following the expansions gave birth at higher quality hospitals—facilities with neonatal intensive care units and those with low postnatal complication rates. In the second chapter, I continue investigating the effects of expansion, but examine its impact on hospitals' provision of indigent care, along with the impact of the Balanced Budget Act of 1997, with its reductions in Medicare and Medicaid hospital payments, on hospitals' supply of indigent care. The definition of hospital indigent care is, for the purpose of this dissertation, based on uncompensated care costs in dollars, volume of the uninsured, and amounts of unprofitable services provided. Using the Florida hospital data for 1990-2000, I find that these two health care policies reduced hospitals' provision of indigent care, but to different extents, and that the policy impacts differed by hospital ownership type. The third chapter, a joint project with Kosali Simon, examines the impact of the Children's Health Insurance Program on hospital utilization for low-income children. The expansion of public insurance coverage results in two contrasting effects that could increase or decrease hospital care for low-income children. On the one hand, the gain of public insurance coverage will increase access to primary care, and this may prevent hospitalizations, particularly those with ambulatory care sensitive conditions, to some degree. On the other hand, the coverage gain means lower costs of care and thus may increase hospital care across the board. Using the NIS for 1996-2002, we find that hospitalization rates and intensity of care increased overall, but these increases originated from increased non-ambulatory care sensitive hospitalizations.
dissertation or thesis