Panel: Understanding the Changing Landscape of Hospital Care for Low-Income Patients

Friday, November 8, 2019: 1:30 PM-3:00 PM
I.M Pei Tower: Majestic Level, Majestic Ballroom (Sheraton Denver Downtown)

*Names in bold indicate Presenter

Organizer:  Rebecca M. Sachs, Harvard University
Panel Chair:  Sandra Decker, Agency for Healthcare Research and Quality
Discussants:  Laura Dague, Texas A&M University and Seth Freedman, Indiana University

This session will focus on policy issues surrounding hospital care for Medicaid beneficiaries and the uninsured. Understanding the interactions between hospitals and low-income patients is important given the many policy changes that have taken place in recent years.  The ACA Medicaid expansion, growth in Medicaid managed care, and slated cuts to disproportionate share hospital payments have led to changes in hospital payer mix and reimbursement. At the same time, hospital markets have become increasingly concentrated with many providers merging and closing.

This panel brings together four papers that leverage quasi-experimental empirical frameworks to evaluate the implications of the changing landscape of hospital care for low-income patients. In the first paper, Rebecca M Sachs studies how government and private hospitals compete in markets for low-income care by looking at changes in hospital provision of inpatient psychiatric care in California. In the second paper, Sayeh S Nikpay exploits variation Medicaid enrollment to study the target efficiency of federal hospital safety-net subsidy programs such as Medicare DSH and 340b.

While the first two papers to focus on government financing of safety-net hospital care for low-income individuals, the next two papers focus on how shifts in the hospital market affect Medicaid beneficiaries. In the third paper, William L Schpero studies how concentration of care for Medicaid beneficiaries within certain hospitals affects patient outcomes. Finally, in the fourth paper, Sunita Desai and coauthors look at the impacts of hospital mergers on provision of care for Medicaid patients in New York.

The Impact of Hospital Market Consolidation on Care for Low-Income Populations: Evidence from New York Medicaid
Sunita Desai1, Sherry Glied1 and Jacob Wallace2, (1)New York University, (2)Yale University

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