title: Specialty versus community hospitals: what role for the law?
abstract: U.S. health care has long featured a struggle between regulation and markets as vehicles of reform, and the community hospital is at the center of this struggle. The key to its financial viability is cross-subsidization, whereby revenues from insured patients subsidize the care of the uninsured and underinsured, and profits from well-compensated services support those operating at a loss. Cross-subsidization has been challenged by efforts to move highly compensated services and well-insured patients to ambulatory surgical centers and specialty hospitals. We review the ongoing battle between through a legal lens and offer conjectures about the outcome. Refined certificate-of-need regulation may be the preferable policy choice.
authors.affiliation: Faculty of Law, Faculty of Medicine, and Joint Centre for Bioethics, University of Toronto, Ontario. sujit.choudhry@utoronto.ca
authors.forename: Sujit
authors.initials: S
authors.lastname: Choudhry
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
authors.forename: Troyen A
authors.initials: TA
authors.lastname: Brennan
mesh_terms: D005377:Financial Management, Hospital; D033161:Government Regulation; D006764:Hospitals, Community / Q000191:economics* / Q000331:legislation & jurisprudence*; D006782:Hospitals, Special / Q000191:economics* / Q000331:legislation & jurisprudence*; D014481:United States