Health Equity and the Allocation of COVID-19 Provider Relief Funds

COVID-19 Provider Relief Fund Payments Were Appropriately Targeted And Did Not Boost Selected Hospitals' Profits

To help mitigate the COVID-19 pandemic's financial effects on health care providers, Congress allocated $178 billion to the Provider Relief Fund (PRF) beginning in 2020. Using monthly data from January 2018 through June 2022 from a nationally representative sample of US hospitals, we used a difference-in-differences approach to examine whether hospitals receiving medium and high PRF support intensity had higher average monthly operating margins (measured separately with and without accounting for PRF payments) than those that received low PRF support intensity. We also assessed the impact of PRF payments by hospitals' prepandemic financial vulnerability status, measured by whether their average operating margins in 2018 and 2019 were above or below the national median. Our findings indicate that PRF distributions to hospitals were appropriately targeted and did not make some hospitals significantly more profitable than others; rather, PRF payments helped offset financial losses associated with the pandemic. The effects of PRF support intensity were concentrated among hospitals that were financially vulnerable before the pandemic and thus in need of support to remain financially viable during the crisis.

Participation in the CARES Act Provider Relief Fund policy by dentists in South Carolina's safety net

OBJECTIVES

The Coronavirus Aid, Relief, and Economic Security (CARES) Act appropriated $100 billion to the Provider Relief Fund, allowing for direct payments to health care providers due to COVID-19. Few studies have evaluated participation in the Provider Relief Fund (PRF), and none have specifically looked at dental providers in the safety net.

METHODS

We conducted a retrospective, secondary data analysis using a quasi-experimental cohort design of South Carolina dentists who received PRF payments, comparing those who did and did not participate in the safety net. Safety net practice was operationalized as those participating in Medicaid, and whether they provided care in dental health professional shortage areas, or rural communities.

RESULTS

Of the 628 dental providers in South Carolina who received PRF payments, 34% were identified as Medicaid providers while 66% did not participate in Medicaid; we found no statistical difference between payments to Medicaid versus non-Medicaid dental providers. Of PRF payments to dental providers participating in South Carolina's Medicaid program, we found no difference between payments to rural and urban providers but did find that practices offering services in dental care shortage areas received less than providers practicing in counties not designated as a shortage area.

CONCLUSIONS

The PRF achieved its goal of distributing financial support to providers affected by the COVID-19 pandemic. But without policy imperatives linked to need-based allocations or incentives for PRF recipients to serve safety net populations, we may later learn this was a missed opportunity for PRF.

Financial Outcomes Associated With the COVID-19 Pandemic in California Hospitals

Importance

The COVID-19 pandemic challenged the financial solvency of hospitals, yet there is limited evidence examining hospital financial performance through the first 15 months of the pandemic.

Objective

To assess the financial outcomes associated with the COVID-19 pandemic in California hospitals.

Design, Setting, and Participants

This cross-sectional study tracked the financial performance of 348 hospitals in California using Hospital Quarterly Financial and Utilization Data from the State of California Office of Statewide Health Planning and Development. Hospital financial performance was examined from January 2019 to June 2021 for all hospitals in aggregate and by safety-net status.

Exposures

Pre–COVID-19 financial outcomes vs COVID-19 period outcomes.

Main Outcomes and Measures

Quarterly revenues, expenses, and profits.

Results

In 348 California hospitals, hospital financial performance was highly variable during the COVID-19 pandemic. Losses were reduced by COVID-19 relief funding and strong equities market performance starting in the second quarter of 2020. Non–safety net hospitals maintained positive operating margins throughout the pandemic, while safety-net hospitals experienced large losses. Between the first quarter of 2020 and the second quarter of 2021, California safety-net hospitals’ net operating losses were more than $3.2 billion.

Conclusions and Relevance

In this cross-sectional study of California hospitals, hospital financial performance was tracked between the first quarter of 2019 and the second quarter of 2021. Although hospitals experienced reduced profits between January 2020 and June 2021, the interventions of government assistance programs were able to mitigate more detrimental fiscal consequences. When compared with non–safety net hospitals, safety-net hospitals were confronted with more concentrated financial losses.

Ethics of U.S. government policy responses to the COVID‐19 pandemic: A utilitarianism perspective

COVID‐19 hit the United States in January 2020, quickly resulting in stay‐at‐home orders that sent the U.S. economy into a major recession. The federal government leveraged fiscal, regulatory, and monetary policies to provide relief. Decisions had to be made in a complex environment wrought with difficult choices, complicated by the federalist governing system in the United States. Myers (2016, p. 202) asserted, “If an event like the [1918 influenza] pandemic were to occur in the United States, it is important that the government be prepared, not only in terms of material, but ethically.” We analyze the ethical choices of the initial responses by reviewing early U.S. government responses and the impact of culture, federalism, and justice. We conclude that utilitarian analyses of balancing infection rates and economic impacts must be supplemented with Kantian principles of not treating people as means to an end, balancing the protection of individual freedoms with the good of society, and protecting vulnerable groups. As governments prepare for future crises, ethical considerations should be built into those plans as guardrails to guide decision‐makers.