The Effects of Government Regulation on Providing Healthcare at United States Hospitals Between 1997 and 2010

Goals and Objectives The purpose of this study is to examine the effects of the Balance Budget Act of 1997 (BBA97) on providing healthcare by United States hospitals between 1997 and 2010. The insights gained as to the effects of regulation between 1997 and 2010 will provide future direction to research on more recent government regulations, such as the Patent Protection and Affordable Care Act of 2010. BBA7 will be examined through the following research questions: 1. Explore potential effects of federal legislation on amount of reimbursement available to hospitals accepting Medicare payments between 1997 and 2010 taking into account adjusted dollar value, relative value units (RVU), and geographical practice cost indices (GPCI). 2. Explore effects of major government regulation on the number of patient beds in acute care hospitals for cardiovascular care and obstetrics at the state level between 1997 and 2010. 3. Explore potential effect of federal legislation on physicians leaving private practice and not entering into employment practice in hospitals between 1997 and 2010. Theoretical Framework The relationship between cost, quality, and access is explained by the iron triangle of healthcare. According to the Iron Triangle, one or two of the points can be increased but at the expense of the opposite point or points. Methodology Utilizing the Area Health Resource File, three mixed effects models were run by Medicaid expansion status to find the best fit model: random slope, random intercept, and random slope intercept. The purpose of expansion status grouping was to determine if there were historical differences between states based on their expansion status. Field Significance The key implication of this research for public health practice is even though many public health programs are funded utilizing a top-down approach, the variation in health status due to socio-demographic and environmental factors at the local level must be considered. Healthcare and public health are not one-size fits all programs. Just as medical interventions must be specifically for each individual for maximum safety and effectiveness, so must public health interventions be tailored for specific communities. Outcomes 1. Medicaid reimbursement rates increased less than the cost of providing care over the study period. 2. Inpatient licensed bed counts decreased between 1997 and 2010. However, the variation in specific bed type cannot be accounted for by time. 3. Physicians leaving private practice and not entering employed practice had more to do with federal than state regulations during the study period. 4. Medicaid expansion states were not significantly different than non-expansion states on reimbursement, bed count, or physicians leaving private practice in the years before the passage of the Affordable Care Act