Date of Award
Spring 2-23-2023
Embargo Period
2-23-2023
Document Type
Dissertation
Degree Name
Doctor of Health Administration
Department
Health Administration
College
College of Health Professions
First Advisor
Dunc Williams
Second Advisor
Jiebing Wen
Third Advisor
Timothy Putnam
Abstract
Research Objective
Mississippi's healthcare systems are ranked 49 out of 50 on many overall performance indicators, including access to care, quality of care, cost and utilization of services, health outcomes, and income-based healthcare disparities. Nationally, some evidence suggests coverage gaps are wider and growing faster in states that have yet to adopt Medicaid expansion. Multiple hospitals across Mississippi are currently experiencing financial instability, which could cause service reductions or closures, particularly in rural (54%) areas such as the Mississippi Delta. Because of these performance constraints, we evaluated Mississippi hospital uncompensated care costs, total margins, and operating margins for years 2011-2020. We then compared those outcomes to Arkansas, a state that expanded Medicaid in 2014, which is geographically contiguous to Mississippi and similar in many respects (demographics, population, rurality, etc.,). The objective of this study was to describe and compare changes in Mississippi hospitals’ financial performance to Arkansas hospitals’ performance, pre- and post- Medicaid Expansion.
Study Design
This research is a quantitative research design that provided descriptive statistics on Mississippi hospitals compared to hospitals in Arkansas, a state that adopted ACA Medicaid Expansion early on January 1, 2014, using a descriptive difference-in-differences approach. This approach compared two differences, the treatment group – the state of Arkansas, and the control group – the state of Mississippi. The data includes years 2011-2013 for pre-expansion and 2015-2020 for post-expansion. Key outcomes of this evaluation include uncompensated care costs, operating margins, and total margins in Mississippi Hospitals. The primary data source is Healthcare Cost Reporting Information System (HCRIS) Cost Reports between 2011-2020.
Population Studies
We evaluated all hospitals in Mississippi and Arkansas that reported Healthcare Cost Reporting Information System (HCRIS) Cost Reports in 2011-2020.
Principal Findings
When compared to Mississippi in the pre-expansion period, Arkansas had slightly more uncompensated care costs. Post Medicaid Expansion, uncompensated care cost percentages declined for hospitals in Arkansas and stayed down compared to hospitals in Mississippi, where we saw a slight increase. When compared to Mississippi in the pre-expansion period, Arkansas reported more bad debt. Post Medicaid Expansion, the amount of bad debt incurred by hospitals declined constantly in Arkansas, compared to hospitals in Mississippi, where we saw an increase, then a slight decrease to where Arkansas was at expansion in 2014. In evaluating total and operating margins pre-expansion, Mississippi performed better; however, post-expansion Mississippi always performed worse financially. Post-expansion, Arkansas improved profit margin. Due to the COVID-19 pandemic and government relief funding, results varied in 2019 and 2020. Overall, our results show that all four measures (uncompensated care costs, bad debt, total margins, and operating margins) improved significantly in Arkansas post-Medicaid Expansion compared to Mississippi.
Conclusions
Mississippi performed better on all measures pre-2014 and performed worse on all measures post- 2014. Overall, our results show that all four measures (uncompensated care costs, bad debt, total margins, and operating margins) improved significantly in Arkansas post-Medicaid Expansion compared to Mississippi.
Implications for Policy or Practice
Ultimately, not choosing to expand Medicaid could potentially lead to financial constraints and solvency concerns among hospitals in those states. Our findings may inform policymakers in non-expansion states balancing concerns about the effect of Medicaid expansion on state budgets with concerns about the impact on hospital performance.
Recommended Citation
Williams, Edrin R., "Hospital Uncompensated Care Costs and Profits: A Comparison of Mississippi and Arkansas, Pre- and Post- Medicaid Expansion" (2023). MUSC Theses and Dissertations. 766.
https://medica-musc.researchcommons.org/theses/766
Rights
Copyright is held by the author. All rights reserved.