Institutional form is believed to influence organizational behavior and performance in producing collective goods such as healthcare services. Recent efforts in the United States seek to increase healthcare services provided by hospitals, but it is unclear whether and how these organizations respond to the policy changes. In this study, we examine the extent to which nonprofit hospitals change their provision of charity care in response to a regulatory policy specifying a target benchmark aimed at expanding charitable obligations. Specifically, we focus on the minimum charity care provision (MCCP) requirements in Illinois. Importantly, unlike previous research, we differentiate between hospitals facing minimum charity care spending requirements (nonprofits) and those not (for-profit and public). We use panel data from Illinois’ Annual Hospital Questionnaire and county data from the American Community Survey, employing a differences-in-differences model. We find no evidence that nonprofit hospitals increase charity care in response to the MCCP requirements on average. Instead, we find that there is heterogeneity in responses; hospitals providing low levels of charity care prior to the policy increase charity care, while hospitals providing high levels of charity care prior to the policy do not respond or, if anything, decrease charity care. Thus, while regulations that set low-target benchmarks provide insufficient incentives for nonprofit hospitals to increase charity care on average, explicit policy mandates that reduce directive goal ambiguity may still narrow gaps in performance.

中文翻译：

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最低慈善护理提供要求是否会提高非营利医院的绩效？检查医院对监管变化的反应

制度形式被认为会影响组织行为和生产集体产品（如医疗保健服务）的绩效。美国最近努力寻求增加医院提供的医疗保健服务，但尚不清楚这些组织是否以及如何应对政策变化。在这项研究中，我们研究了非营利性医院在何种程度上改变了其慈善医疗服务的提供，以响应一项监管政策，该政策规定了旨在扩大慈善义务的目标基准。具体来说，我们关注伊利诺伊州的最低慈善护理规定 (MCCP) 要求。重要的是，与之前的研究不同，我们区分了面临最低慈善医疗支出要求的医院（非营利组织）和那些没有（营利性和公共）的医院。我们使用来自伊利诺伊州年度医院问卷调查的面板数据和来自美国社区调查的县数据，采用差异中的差异模型。我们没有发现任何证据表明非营利性医院平均会根据 MCCP 的要求增加慈善护理。相反，我们发现反应存在异质性。在政策出台前提供低水平慈善护理的医院增加了慈善护理，而在政策出台前提供高水平慈善护理的医院没有回应，或者，如果有的话，减少了慈善护理。因此，虽然设定低目标基准的法规不足以激励非营利医院平均增加慈善护理，但减少指令目标模糊性的明确政策要求仍可能缩小绩效差距。