title: Responding to financial pressures. The effect of managed care on hospitals' provision of charity care.
abstract: Healthcare financing and insurance is changing everywhere. We want to understand the impact that financial pressures can have for the uninsured in advanced economies. To do so we focus on analyzing the effect of the introduction in the US of managed care and the big rise in financial pressures that it implied. Traditionally, in the US safety net hospitals have financed their provision of unfunded care through a complex system of cross-subsidies. Our hypothesis is that financial pressures undermine the ability of a hospital to cross-subsidize and challenges their survival. We focus on the impact of price pressures and cost-controlling mechanisms imposed by managed care. We find that financial pressures imposed by managed care disproportionately affect the closure of safety net hospitals. Moreover, amongst those hospitals that remain open, in areas where managed care penetration increases the most, they react by closing the health services most commonly used by the uninsured.
authors: IESE Business School and PPSRC Research Center, Av. Pearson 21, 08034 Barcelona, Spain. nmas@iese.edu
authors: Núria
authors: N
authors: Mas
mesh_terms: D003363:Cost Control; D004469:Economics, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D006271:Health Facility Closure / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008329:Managed Care Programs / Q000191:economics*; D017057:Medically Uninsured; D064876:Safety-net Providers / Q000191:economics / Q000706:statistics & numerical data; D017664:Uncompensated Care / Q000191:economics; D014481:United States
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