Health Policy and Administration, School of Public Health, University of Illinois at Chicago, 1603 W Taylor St, Chicago, USA.
BMC Health Serv Res. 2010 Jan 14;10:15. doi: 10.1186/1472-6963-10-15.
During the 1990's hospitals in the U.S were faced with cost containment charges, which may have disproportionately impacted hospitals that serve poor patients. The purposes of this paper are to study the impact of safety net activities on total profit margins and operating expenditures, and to trace these relationships over the 1990s for all U.S urban hospitals, controlling for hospital and market characteristics.
The primary data source used for this analysis is the Annual Survey of Hospitals from the American Hospital Association and Medicare Hospital Cost Reports for years 1990-1999. Ordinary least square, hospital fixed effects, and two-stage least square analyses were performed for years 1990-1999. Logged total profit margin and operating expenditure were the dependent variables. The safety net activities are the socioeconomic status of the population in the hospital serving area, and Medicaid intensity. In some specifications, we also included uncompensated care burden.
We found little evidence of negative effects of safety net activities on total margin. However, hospitals serving a low socioeconomic population had lower expenditure raising concerns for the quality of the services provided.
Despite potentially negative policy and market changes during the 1990s, safety net activities do not appear to have imperiled the survival of hospitals. There may, however, be concerns about the long-term quality of the services for hospitals serving low socioeconomic population.
20 世纪 90 年代，美国的医院面临着成本控制费用，这可能对服务贫困患者的医院产生了不成比例的影响。本文的目的是研究安全网活动对总利润率和运营支出的影响，并在控制医院和市场特征的情况下，追踪这些关系在整个 90 年代的所有美国城市医院的发展情况。
本分析的主要数据来源是美国医院协会的年度医院调查和 1990-1999 年的医疗保险医院成本报告。对 1990-1999 年进行了普通最小二乘法、医院固定效应和两阶段最小二乘法分析。对数总利润率和运营支出是因变量。安全网活动是医院服务区域内人口的社会经济地位和医疗补助强度。在某些规格中，我们还包括了无偿医疗负担。
我们几乎没有发现安全网活动对总利润率产生负面影响的证据。然而，为社会经济地位较低的人群服务的医院支出较低，这引发了对所提供服务质量的担忧。
尽管在 20 世纪 90 年代可能存在负面的政策和市场变化，但安全网活动似乎并没有危及医院的生存。然而，为服务社会经济地位较低人群的医院提供服务的质量可能存在长期担忧。
