A Stochastic Frontier Analysis of California Safety-Net Hospital Cost Inefficiency through the Great Recession

German M. Izon, Chelsea A. Pardini

Abstract


In the United States, safety-net hospitals play a major role in the provision of low-margin services and medical care access for the poor. These integral providers have been shown to be financially disadvantaged compared to their peers. Their weaker financial status may hinder their ability to uphold their valued mission and underscore the importance of cost-efficiency improvements. Using stochastic frontier analysis, with controls for hospital process-of-care quality and patient burden of illness, we estimated California safety-net hospitals’ cost inefficiency for the years 2005 to 2013. The average estimated level of hospital cost inefficiency increased from 10.06 percent to 14.25 percent during the Great Recession and leveled off at 14.03 percent in succeeding years. In recognition of safety-net hospitals’ vital role in the health care system, the uncertainty surrounding uncompensated care, and the planned erosion of disproportionate-share hospital payments, it is pertinent to assess their cost inefficiency through the Great Recession.


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References


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