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Subsidies and Structure: The Lasting Impact of the Hill-Burton Program on the Hospital Industry

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  • Andrea Park Chung
  • Martin Gaynor
  • Seth Richards-Shubik
Abstract
The hospital industry is one of the most important industries in the U.S., and industry structure can have profound effects on the functioning of markets. Using county-level panel data, we study the effect of public subsidies from the Hospital Survey and Construction Act of 1946, known as the Hill-Burton program, on hospital capacity, organization of the hospital industry, and utilization. We find that the program generated substantial increases in capacity and these changes were highly persistent, lasting well beyond twenty years. However the increases in capacity at non-profit and public hospitals were partially offset by reductions in capacity at for-profit hospitals. Nonetheless, we estimate that the Hill-Burton program accounted for a net increase of over 70,000 beds nationwide, which is roughly 17 percent of the total growth in hospital beds in the U.S. from 1948 to 1975. We also show that differences across counties in the number of hospital beds per capita were greatly reduced over this period. Differences between high and low income counties, rural and urban counties, and the South and the rest of the country fell substantially. We conclude that the program largely achieved its goals, and had substantial and long lasting effects on the hospital industry in the U.S..

Suggested Citation

  • Andrea Park Chung & Martin Gaynor & Seth Richards-Shubik, 2016. "Subsidies and Structure: The Lasting Impact of the Hill-Burton Program on the Hospital Industry," NBER Working Papers 22037, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:22037
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    References listed on IDEAS

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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Sam Watson’s journal round-up for 11th December 2017
      by Sam Watson in The Academic Health Economists' Blog on 2017-12-11 18:00:18

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    Cited by:

    1. Hill, Elaine L. & Slusky, David J.G. & Ginther, Donna K., 2019. "Reproductive health care in Catholic-owned hospitals," Journal of Health Economics, Elsevier, vol. 65(C), pages 48-62.
    2. Alex Hollingsworth & Krzysztof Karbownik & Melissa A. Thomasson & Anthony Wray, 2024. "The Gift of a Lifetime: The Hospital, Modern Medicine, and Mortality," American Economic Review, American Economic Association, vol. 114(7), pages 2201-2238, July.
    3. Martin Gaynor & Kate Ho & Robert J. Town, 2015. "The Industrial Organization of Health-Care Markets," Journal of Economic Literature, American Economic Association, vol. 53(2), pages 235-284, June.
    4. Alan Barreca & Karen Clay & Olivier Deschenes & Michael Greenstone & Joseph S. Shapiro, 2013. "Adapting to Climate Change: The Remarkable Decline in the U.S. Temperature-Mortality Relationship over the 20th Century," NBER Working Papers 18692, National Bureau of Economic Research, Inc.
    5. Karen Clay & Joshua A. Lewis & Edson R. Severnini & Xiao Wang, 2020. "The Value of Health Insurance during a Crisis: Effects of Medicaid Implementation on Pandemic Influenza Mortality," NBER Working Papers 27120, National Bureau of Economic Research, Inc.
    6. Vinish Shrestha, 2023. "The Long Shadow of American Slavery: Its Influence on the Affordable Care Act," Working Papers 2023-02, Towson University, Department of Economics, revised Jul 2024.
    7. Zarek Brot-Goldberg & Zack Cooper & Stuart V. Craig & Lev R. Klarnet & Ithai Lurie & Corbin L. Miller, 2024. "Who Pays for Rising Health Care Prices? Evidence from Hospital Mergers," NBER Working Papers 32613, National Bureau of Economic Research, Inc.
    8. HOSHI, Kisho, 2023. "New Medical Schools, Access to Doctors and Health Outcomes : Evidence from Japan," CEI Working Paper Series 2023-05, Center for Economic Institutions, Institute of Economic Research, Hitotsubashi University.
    9. Adam Pilny & Felix Roesel, 2020. "Are Doctors Better Health Ministers?," American Journal of Health Economics, University of Chicago Press, vol. 6(4), pages 498-532.
    10. Theodore F. Figinski & Erin Troland, 2020. "Health Insurance and Hospital Supply: Evidence from 1950s Coal Country," Finance and Economics Discussion Series 2020-033, Board of Governors of the Federal Reserve System (U.S.).
    11. Remco van Eijkel & Mark Kattenberg & Ab van der Torre, 2018. "Competition and pricing behavior in long term care markets: Evidence from the Market for Assistance in Daily Housekeeping Activities," CPB Discussion Paper 373, CPB Netherlands Bureau for Economic Policy Analysis.
    12. Remco Eijkel & Mark Kattenberg & Ab Torre, 2023. "Pricing behavior in long term care markets: evidence from provider-level data for home help services," International Journal of Health Economics and Management, Springer, vol. 23(1), pages 59-83, March.
    13. Martha J. Bailey & Jason M. Lindo, 2017. "Access and Use of Contraception and Its Effects on Women’s Outcomes in the U.S," NBER Working Papers 23465, National Bureau of Economic Research, Inc.
    14. Petek, Nathan, 2022. "The marginal benefit of hospitals: Evidence from the effect of entry and exit on utilization and mortality rates," Journal of Health Economics, Elsevier, vol. 86(C).

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    More about this item

    JEL classification:

    • H25 - Public Economics - - Taxation, Subsidies, and Revenue - - - Business Taxes and Subsidies
    • H32 - Public Economics - - Fiscal Policies and Behavior of Economic Agents - - - Firm
    • H54 - Public Economics - - National Government Expenditures and Related Policies - - - Infrastructures
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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