Medically Necessary but Forbidden: Reproductive Health Care in Catholic-owned Hospitals
The United States has recently seen a large increase in hospital mergers and acquisitions, and Catholic hospital systems have actively participated in this. As of 2016, 40% of the largest healthcare systems were faith-based, with 141 mergers between Catholic and non-Catholic systems since 1997. Mergers that affiliate a hospital with a Catholic owner, network, or system, are consequential because they reduce the set of possible medical procedures since Catholic hospitals are generally prohibited from providing procedures like tubal ligation. We examine the effect of changes in ownership from secular to Catholic (and vice versa) on reproductive health procedures that are likely to be affected. Using hospital-level variation in ownership status for 1002 hospitals, we estimate a difference-in-differences model with year and hospital fixed effects. We find that Catholic hospitals reduce the per bed annual rates of inpatient abortions by 30% and tubal ligations by 31%, whereas there is no significant change in related procedures such as D&Cs or C-sections. Our results are primarily driven by hospitals that change from not Catholic to Catholic. Across a variety of measures, we find minimal overall welfare reductions. However, this decrease in tubal ligations rate alone represents nearly 10,000 fewer tubal ligations per year across the United States, which in itself imposes a substantial cost on women and their partners.
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Document Object Identifier (DOI): 10.3386/w23768