Davidoff A J, LoSasso A T, Bazzoli G J, Zuckerman S
Urban Institute, Washington, DC 20037, USA.
Inquiry. 2000 Fall;37(3):253-67.
This paper examines the effect of changing state policy, such as Medicaid eligibility, payment generosity, and HMO enrollment on provision of hospital uncompensated care. Using national data from the American Hospital Association for the period 1990 through 1995, we find that not-for-profit and public hospitals' uncompensated care levels respond positively to Medicaid payment generosity, although the magnitude of the effect is small. Not-for-profit hospitals respond negatively to Medicaid HMO penetration. Public and for-profit hospitals respond negatively to increases in Medicaid eligibility. Results suggest that public insurance payment generosity is an effective but inefficient policy instrument for influencing uncompensated care among not-for-profit hospitals. Further, in localities with high HMO penetration or high penetration of for-profit hospitals, it may be necessary to establish explicit payments for care of the uninsured.
本文研究了诸如医疗补助资格、支付慷慨程度以及健康维护组织（HMO）参保率等州政策变化对医院无偿医疗服务提供的影响。利用美国医院协会1990年至1995年期间的全国数据，我们发现，非营利性医院和公立医院的无偿医疗服务水平对医疗补助支付的慷慨程度呈正向反应，尽管这种影响的幅度较小。非营利性医院对医疗补助健康维护组织的渗透率呈负向反应。公立医院和营利性医院对医疗补助资格的增加呈负向反应。结果表明，公共保险支付的慷慨程度是影响非营利性医院无偿医疗服务的一种有效但低效的政策工具。此外，在健康维护组织渗透率高或营利性医院渗透率高的地区，可能有必要为未参保者的医疗服务设立明确的支付方式。
