US Hospital Service Availability and New 340B Program Participation

Area of Science:

• Health Services Research
• Health Economics
• Public Health Policy

Background:

• The US 340B Drug Pricing Program offers drug discounts to eligible hospitals to enhance financial stability and patient access.
• It remains unclear if hospitals utilize these savings to subsidize care for low-income or uninsured populations as intended.

Purpose of the Study:

• To assess if the 340B program correlates with improved access to hospital services.
• To determine if this association differs based on hospital ownership (public vs. nonprofit).

Main Methods:

• A difference-in-differences and cohort analysis was conducted using data from 2010-2019.
• The study included general, acute, nonfederal hospitals in the US, merging American Hospital Association data with hospital characteristics.
• New hospital enrollments in the 340B program between 2012-2018 were analyzed.

Main Results:

• Public hospitals newly participating in the 340B program showed a significant increase in unprofitable service lines (e.g., substance use, psychiatric services).
• Nonprofit hospitals demonstrated no significant association with changes in service offerings, except for a marginal increase in oncologic services.
• Participating hospitals were more likely to be critical access, teaching, rural, and located in Medicaid expansion states.

Conclusions:

• Public hospitals appear to use 340B savings to expand access to essential, often unprofitable, services.
• Nonprofit hospitals' responses to the 340B program regarding service offerings were minimal.
• The heterogeneous impact of the 340B program based on hospital ownership warrants consideration in policy evaluations and eligibility criteria.