Hospitals Flashcards
What is the definition of a hospital?
licensed institutions with at least six beds who provide diagnostic and therapeutic patient services for medical conditions, have organized physician staff, and provide continuous nursing services under the supervision of RNs
When did insurance emerge?
1930s-1965
Medicare and Medicaid in 1965
What is vertical integration?
Integrating different operations at different levels of care
What is a nonprofit hospital?
A regulatory status in which the firm enjoys a competitive advantage through tax exemptions, but their profits cannot be distributed to shareholders
What are nonprofit hospital mission statements like?
States their mission like delivering community benefits and helping low-income patients
What law regulates nonprofit hospitals?
Section 501(c)(3)
What are some examples of community benefits?
- operating an emergency room open to all, regardless of ability to pay
- maintaining a board of directors drawn from the community
- maintaining an open medical staff policy
- providing hospital care for all patients able to pay
- using surplus funds to improve facilities, equipment, and patients care
- using surplus funds to advance medical training, education, and research
What are safety-net hospitals?
- a place to care for disadvantaged populations and tend to have higher rates of Medicaid-funded and uncompensated care
- no real definition
Are safety-net hospitals highly ranked?
Nah they lowkey perform ass
Why is it theorized that safety-net hospitals perform so poorly?
Tension between margin and mission, the financial constraints of SNHs may be a key contributor to lower performance on quality measures
What are disproportionate share hospitals?
Hospitals that serve low-income patients and receive payments from the Center for Medicare and Medicaid Services to cover the costs of providing care
How do pharmaceutical manufacturers and Disproportionate Share Hospitals interact?
If the share adjustment percentage is above 11.75%, the hospital is eligible for the 340B Program which forces pharma manufacturers participating in Medicaid to sell the DSH discounted drugs
What is a critical access hospital?
A hospital that
- has 25 or less acute care inpatient beds
- located more than 35 miles from another hospital
- maintaining an average length of stay of 96 hrs or less for acute care
- provides 24/7 emergency care services
What is a major reason for the decrease in hospital beds?
Shift to outpatient services
What is cost shifting?
When a hospital charges patients with higher reimbursement rates more to offset costs of publicly-insured and uninsured patients
What is cross subsidization?
Involves overcharging for profitable services to pay for unprofitable ones
Is cross subsidization easy to study?
NO! It’s not transparent and changes in volume doesnt tell the whole story
What are some effects of cross subsidization?
- reductions in admissions
- hospitals increased profitable services and reduced unprofitable ones
What is Bai et al.’s study look into?
If nonprofit hospitals’ charity care is aligned with their favorable tax treatment?
What did Bai et al.’s study find?
Nonprofit hospitals had a lower aggregated charity-care-to-expense ratio than for profit hospitals
Calling into question is the tax exemption is justified
What are some policy recommendations that can help the tax exemption issue?
- creating a ranking system that builds on the transparency approach
- floor and trade system that builds on the minimum requirement approach, taking into account heterogeneity in the demand for charity care by geography
- revisit tax exemption rules for nonprofit hospitals
