Hospital Financial Pressures and the Health of the Uninsured: Who Gets Hurt? The Case of California

24 Pages Posted: 23 Apr 2009 Last revised: 19 May 2009

See all articles by Núria Mas

Núria Mas

University of Navarra - IESE Business School

Date Written: March 2, 2009

Abstract

The US relies on charitable medical care to serve the uninsured, most of which is offered by hospitals that act as providers of last resort and that constitute the safety net. This paper analyzes the effect that hospital financial stress has on the health of the uninsured. In particular we look at managed care. Managed care penetration has often been blamed for increasing financial pressures on hospitals and previous work has showed that safety net hospitals have been affected more severely by it. Our findings are threefold: first, we find that managed care financial pressures encourage charity care patients to concentrate in public hospitals. Second, we fins that these hospitals, in turn, see a decrease in their quality of care in areas where managed care penetration is stronger. Finally we also find that managed care diffusion has a negative effect on the quality of care received by the uninsured - as measured by the probability of dying after a heart attack - and of those that go to government hospitals.

Keywords: uninsured, hospitals, financial care, quality

Suggested Citation

Mas, Núria, Hospital Financial Pressures and the Health of the Uninsured: Who Gets Hurt? The Case of California (March 2, 2009). IESE Business School Working Paper No. 789, Available at SSRN: https://ssrn.com/abstract=1392763 or http://dx.doi.org/10.2139/ssrn.1392763

Núria Mas (Contact Author)

University of Navarra - IESE Business School ( email )

Avenida Pearson 21
Barcelona, 08034
Spain

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