Analysis of the Joint Distribution of Disproportionate Share Hospital Payments. 3. Hospital Data Set


In this chapter, we provide a general overview of data sources and variables used in our analyses. We used the data set to support the following analytic tasks:

  • determine the current distribution of Medicare and Medicaid DSH expenditures at the individual hospital level and by key hospital characteristics;
  • assess alternative definitions of safety net providers;
  • evaluate alternative measures of financial vulnerability; and,
  • determine how well the current policies and alternative allocation policies target financially vulnerable safety net hospitals. The alternative allocation policies are based on:
    • utilization data;
    • revenue data; and,
    • uncompensated care and other cost data.

Ideally, all required data would be available for all hospitals across the country for the same time period. Substantial information on individual hospital characteristics is available from the national sources discussed below. However, some utilization and financial data that are needed to measure hospital services to low-income populations (or at least the resources devoted to Medicaid patients and self-pay patients) are not directly available. Detailed inpatient utilization data on self-pay patients are available only for the 20 percent sample of hospitals from the 24 states included in the Hospital Cost and Utilization Project (HCUP) database. Much of the needed information on revenues by payer and on uncompensated care is collected in the American Hospital Association (AHA)'s Annual Survey, but confidentiality considerations preclude using that information for detailed exploratory analyses requiring hospital-level information. Thus, we supplemented the available national data with the HCUP national sample and detailed claims and financial data from three states: California, New York, and Wisconsin.

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