Do Public Hospitals Affect Private Insurance Choice. Public Insurance asSubstitutes for Private Insurance: New Evidence about Public Hospitals. Abstract, Executive Summary and Final Report

摘要

Public hospitals have been important providers of health care for Medicaidenrollees and the uninsured. In this paper, public hospitals are modeled as public subsidy to health care providers for providing care to the uninsured. However, a possible cost of this type of provision is that by offering an alternative to the private insurance market, the proximity of free or subsidized care may decrease the incentive to purchase private health insurance. Individual-level data for respondents under age 65 was obtained from the 1987 National Medical Expenditure Survey (NMES). The sample was divided into three groups: those with household incomes below the poverty level (n=2,836), between 100-400% (n=13,113), and greater than 400% of the poverty level (n=7,793). Multinomial logit regressions are estimated for the low and middle income groups where the dependent variable (insurance) can take one of three values: private insurance, Medicaid, or no insurance, while a binomial probit (private insurance or no insurance) is estimated for the high income group. For people below the poverty level and those with high incomes, public hospitals proximity is not related to insurance coverage. Those in the middle income group, however, are shown to be less likely to be privately insured if a public hospital is in their county. For the low-income group, the presence of a public hospital was associated with a lower likelihood of Medicaid coverage. The accessibility of public hospitals to care for the poor may give individuals an incentive to forego private insurance and rely instead upon public provision of medical care.