Our objective is to assess and compare the effects of cost control strategies, including Medicaid payment restrictions. State rate-setting and HMOs, on access to and use of inpatient and ambulatory hospital care by the poor and uninsured. These effects will be measured using data for 1976-1984 from the National Health Interview Survey and Hospital Discharge Survey.
Specific aims to be addressed are: (1) Examine changes over time in access to hospital care among individuals with low incomes and assess the influence of provider, regulatory and financing characteristics on receipt of hospital services and level of use. (2) Among Medicaid eligibles, examine the impact of changes over time and across states im Medicaid eligibility and benefit structure on the receipt of hospital services and level of use. (3) Among individuals with low incomes who are uninsured, determine the extent to which access to ambulatory and inpatient services has declined, and the extent to which state policies toward indigent care have attenuated the effects of cost containment efforts. As a complement to the population-based analysis of access and use, hospital behavior relative to cost control and uncompensated care will be examined. Specifically, survey and financial report data will be used to estimate models of hospital behavior relative to decisions to servie those with low incomes, and particularly those with no insurance. It is recognized that hospitals can take a variety of actions to limit the burden of uncompensated care, including screening admissions, collection efforts, closing departments or clinics that generate high levels of uncompensated care and transferring indigent patients to other institutions. Models will be estimated to examine the influence of cost containment and indigent care financing arrangements on these types of hospital decisions.
