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The Fragmentation of U.S. Health CareCauses and Solutions$
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Einer Elhauge

Print publication date: 2010

Print ISBN-13: 9780195390131

Published to Oxford Scholarship Online: May 2010

DOI: 10.1093/acprof:oso/9780195390131.001.0001

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Ending the Specialty Hospital Wars

Ending the Specialty Hospital Wars

A Plea for Pilot Programs as Information-Forcing Regulatory Design

(p.235) 11 Ending the Specialty Hospital Wars
The Fragmentation of U.S. Health Care

Frank Pasquale

Oxford University Press

This chapter focuses on the need for more targeted assessment of the impact of market forces on communities. Pilot programs encourage experimentation in the delivery system without risking widespread disruption of care for the uninsured and emergency services. The Center for Medicare & Medicaid Services (CMS) has already embraced the idea of pilot programs in other contexts, and they could be especially appropriate if specialty hospitals were permitted in markets where general hospitals had a demonstrably poor record of community service. In such markets, cross-subsidization is probably already low, and specialty hospital threats to it are not as much of a concern as they are in areas where general hospitals consistently serve a substantial base of indigent and uninsured patients. Part II of the chapter makes the case for pilot programs by laying out basic facts about the current performance of specialty hospitals. Part III describes the increasingly complex legal landscape surrounding them—including directly applicable provisions of state and federal laws, and incumbent hospitals' strategies to deploy other regulations, statutes, and common law to gain competitive advantage. After briefly describing the drawbacks of all these strategies, Part IV advances the positive contribution of the chapter: a turn to pilot programs that would promote an evidence-based response to the rise of specialty hospitals.

Keywords:   health care policy, cross-subsidization, tax policy, health care system, specialty hospitals, pilot programs

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