Politics, hospital behaviour and health care spending

Zack Cooper, Amanda Kowalski, Eleanor Neff Powell and Jennifer Wu

CEP Discussion Papers from Centre for Economic Performance, LSE

Abstract: This paper examines the link between legislative politics, hospital behaviour, and health care spending. When trying to pass sweeping legislation, congressional leaders can attract votes by adding targeted provisions that steer money toward the districts of reluctant legislators. This targeted spending provides tangible local benefits that legislators can highlight when fundraising or running for re-election. We study a provision - Section 508 - that was added to the 2003 Medicare Modernization Act (MMA). Section 508 created a pathway for hospitals to apply to get their Medicare payment rates increased. We find that hospitals represented by members of the House of Representatives who voted 'Yea' on the MMA were significantly more likely to receive a 508 waiver than hospitals represented by members who voted 'Nay.' Following the payment increase generated by the 508 program, recipient hospitals treated more patients, increased payroll, hired nurses, added new technology, raised CEO pay, and ultimately increased their spending by over $100 million annually. Section 508 recipient hospitals formed the Section 508 Hospital Coalition, which spent millions of dollars lobbying Congress to extend the program. After the vote on the MMA and before the vote to reauthorize the 508 program, members of Congress with a 508 hospital in their district received a 22% increase in total campaign contributions and a 65% increase in contributions from individuals working in the health care industry in the members' home states. Our work demonstrates a pathway through which the link between politics and Medicare policy can dramatically affect US health spending.

Keywords: health care; US; hospital; politics (search for similar items in EconPapers)
JEL-codes: D72 H51 I10 I18 P16 (search for similar items in EconPapers)
Date: 2017-12-14
New Economics Papers: this item is included in nep-cdm, nep-hea and nep-pol
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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Related works:
Working Paper: Politics, Hospital Behavior, and Health Care Spending (2017)
Working Paper: Politics, hospital behaviour and health care spending (2017)
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Persistent link: https://EconPapers.repec.org/RePEc:cep:cepdps:dp1523

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