Núria Mas

Responding to Financial Pressures - The Effect of Managed Care on Hospitals' Provision of Charity Care

Healthcare financing and insurance is changing everywhere. We want to understand the impact that financial pressures can have for the uninsured in advanced economies. To do so we focus on analyzing the effect of the introduction in the US of managed care and the big rise in financial pressures that it implied. Traditionally, in the US safety net hospitals have financed their provision of unfunded care through a complex system of cross-subsidies. Our hypothesis is that financial pressures undermine the ability of a hospital to cross-subsidize and challenges their survival. We focus on the impact of price pressures and cost-controlling mechanisms imposed by managed care. We find that financial pressures imposed by managed care disproportionately affect the closure of safety net hospitals. Moreover, amongst those hospitals that remain open, in areas where managed care penetration increases the most, they react by closing the health services most commonly used by the uninsured.

COMPARING NON-FATAL HEALTH ACROSS COUNTRIES: IS THE US MEDICAL SYSTEM BETTER?

The primary focus of the paper is to assess whether the US, which spends significantly more than any other country in health care, has better health outcomes. It has long been clear that mortality as a whole is not better in the US than in other countries. We focus our analysis on the US performance for the treatment of non-fatal health outcomes and we compare the health of the United States to that of Canada, the United Kingdom and Spain. Our results indicate a discrepancy between high quality of life for some outcomes and low quality of life for others. Such discrepancy is not attributable to measurement issues in determining a persons quality of life, nor is it attributable to differing performance by income. Our results suggest that the discrepancy is due to the fact that the US does better for the treatment of conditions where high-tech medicine is a key to better health and worse in conditions requiring substantial chronic disease management.

Hospital Financial Pressures and the Health of the Uninsured: Who Gets Hurt?

The increasing financial pressures of health care insurance coverage have become a key issue for advanced economies. This study tests whether hospital financial pressures have an effect on the health of the uninsured population. To do so, the author investigates the implications of managed care for the uninsured in the United States. Managed care penetration has increased financial pressures on hospitals, and previous work has shown that safety net hospitals have been affected more severely. The study results reveal that charity care patients concentrate in government hospitals in areas where financial pressures imposed by managed care are greater. In addition, the quality of care of these hospitals decreases more in areas where managed care penetration is stronger. Finally, the stronger financial pressures that managed care diffusion imposes have a negative effect on the quality of care the uninsured and those admitted to government hospitals receive.

European Commission decisions on anti-competitive behavior

This paper provides an analysis of all the European Commissions decisions on anti-trust cases between January 1999 and February 2004. We use a unique dataset that contains information not only on the cases that were analyzed by the Commission and for which a decision was finally made public, but also on all the cases that were never pursued any further and those for which there is no final public decision. We have two goals. First, this data allows us, for the first time in the literature, to determine whether there is any type of bias in the selection process followed by the Commission when deciding which cases to pursue until a final decision is reached. Our results show that the selection of cases is not random and that it is quite efficient. Second, we can help to determine whether the criteria that have been shown by the economic literature to play an important role in anti-competitive behavior are also important for the Commissions decisions in anti-trust cases. Our results suggest that this is the case.

The Effects of Wealth on Health. Micro-Evidence from Homeowners' Housing Wealth Misestimation

The debate on the impact of economic conditions on health has been recently amplified by the drug crisis in the US attributed by some to “deaths of despair.�? There is little understanding of the magnitude of the impact of economic conditions on health and the reasons why it varies across socioeconomic groups and geographical areas. We show that housing is an important unexplored driver that explains these differences. We exploit the fact that households that overvalue (undervalue) their houses experience an unexpected negative (positive) shock in their housing wealth when they sell their houses. We find that a one standard deviation positive shock in housing wealth increases the probability of an improvement in self-reported health by 1.13 percentage points and decreases the drug-related mortality rate by 0.27. We exploit the geographical variation in unexpected housing wealth shocks and find that households who live in MSAs with more inelastic housing supply experience larger changes in health outcomes.

The Importance of Technology in the Consolidation of Hospital Markets - The Case of the United States

Over the last years, technology has become a key element of competition in the hospital market. At the same time, this market in the US has experienced an enormous merger activity. In this study, we analyze the role that technology can play in this consolidation wave by focusing on how it can affect a hospital´s selection of a particular target. We analyze the selection of targets in mergers that took place in the US hospital market between 1985 and 2000. Our results show that technology is an important element for the competition in the hospital market and, as such, it plays a relevant role also in M&A strategies. We find that hospitals are more likely to choose targets that complement their technological holding, specifically when these are complex technologies and with favorable cost/benefits ratios. With this, the merged entity tends to become closer to a one-stop-shop hospital.

Hospital financial pressures and the health of the uninsured. Who gets hurt? The case of California

The increasing financial pressures of health care insurance coverage have become a key issue for advanced economies. This study tests whether hospital financial pressures have an effect on the health of the uninsured population. To do so, the author investigates the implications of managed care for the uninsured in the United States. Managed care penetration has increased financial pressures on hospitals, and previous work has shown that safety net hospitals have been affected more severely. The study results reveal that charity care patients concentrate in government hospitals in areas where financial pressures imposed by managed care are greater. In addition, the quality of care of these hospitals decreases more in areas where managed care penetration is stronger. Finally, the stronger financial pressures that managed care diffusion imposes have a negative effect on the quality of care the uninsured and those admitted to government hospitals receive.

Biotechnology in Catalonia; Industry Analysis

Biotechnology is considered one of the key engines to achieving long-term sustainable growth. Catalonia is the main player in the Spanish biotechnology market, boasting 35 percent of the Spanish biotech R&D and 24 percent of its firms. In this report, we analyze the state of the Catalan biotechnology sector, focusing on its competitive advantages and disadvantages relative to other European biotech clusters. Our findings indicate that, in Catalonia, the biotechnology sector has the potential to affect sectors that represent 10 percent of the Catalan GDP and that employ 9.3 percent of the Catalan workforce. However, Catalan biotech is still quite small in relation to the top European bioclusters and it is only slowly catching up in some of its strategic components. The main advantages of the Catalan biotechnology sector are, first, its research effort, which has been improving steadily, thus allowing Catalonia to start closing the gap with Europe, especially in industrial biotechnology. Second, the attractiveness of Barcelona to draw key staff. The main challenge it faces is access to funding and the fact that the size of related industries in the area is smaller than their size in the top European biotech regions. Finally, 65 percent of Catalan biotechnology firms are devoted to the health sector, while the performance of biotech research in the industrial sector has been particularly competitive.