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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.