Public vs. Private Provision of Charity Care? Evidence from the Expiration of Hill-Burton Requirements in Florida

41 Pages Posted: 8 Mar 2010 Last revised: 3 Mar 2021

See all articles by Douglas Almond

Douglas Almond

Columbia University - Graduate School of Arts and Sciences, Department of Economics; National Bureau of Economic Research (NBER)

Janet Currie

Princeton University; National Bureau of Economic Research (NBER); Institute for the Study of Labor (IZA)

Emilia Simeonova

Johns Hopkins University - Carey Business School

Date Written: March 2010

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 1989-2003 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. There they received more intensive services, but did not experience improvements in health. These results suggest that public hospitals provided services less efficiently than private hospitals constrained to provide charity care.

Suggested Citation

Almond, Douglas Vincent and Currie, Janet and Simeonova, Emilia, Public vs. Private Provision of Charity Care? Evidence from the Expiration of Hill-Burton Requirements in Florida (March 2010). NBER Working Paper No. w15798, Available at SSRN: https://ssrn.com/abstract=1565898

Douglas Vincent Almond (Contact Author)

Columbia University - Graduate School of Arts and Sciences, Department of Economics ( email )

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Janet Currie

Princeton University ( email )

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Emilia Simeonova

Johns Hopkins University - Carey Business School ( email )

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