title: The relationship between the Balanced Budget Act and length of stay for Medicare patients in US hospitals.
abstract: BACKGROUND
  The Balanced Budget Act (BBA) of 1997 and Balanced Budget Refinement Act (BBRA) of 1999 led to deep financial cuts for hospitals and nursing homes.
  
  
  OBJECTIVE
  We examine the effects of these acts on hospital length of stay (LOS) for Medicare recipients.
  
  
  METHODS
  Using data for all short-stay community hospitals in the country, we compared LOS for Medicare patients before and after the BBA/BBRA relative to known determinants of LOS, e.g., hospital ownership, region, beds, financial performance, and conversion/change in ownership type.
  
  
  RESULTS
  Hospital LOS was reduced as a result of the acts. Reductions were more apparent for larger urban hospitals that provided safety-net services. LOS varied slightly by hospital ownership.
  
  
  CONCLUSIONS
  This study is among the first to evaluate the impact of BBA and BBRA on hospital services. These acts had a negative effect on the ability of hospitals to continue offering safety-net services and negatively affected LOS.
authors.affiliation: School of Health Sciences, Jackson State University, Jackson, MS 39213, USA. younis99@gmail.com
authors.forename: Mustafa Z
authors.initials: MZ
authors.lastname: Younis
authors.forename: Dana A
authors.initials: DA
authors.lastname: Forgione
mesh_terms: D002017:Budgets / Q000331:legislation & jurisprudence; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D006764:Hospitals, Community / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D016344:Medicare Part A / Q000191:economics*; D014481:United States