The Yale Undergraduate Research Journal


Jarrett Bell


Since adoption of the Affordable Care Act, hospital concentration has increased across the country, with alarming implications for healthcare affordability. This paper finds evidence that hospital concentration is associated with increases in tax revenue and property tax revenue per capita within a city. The relationship between hospital concentration and taxes is strongest in cities with higher tax revenues, with higher nonprofit ownership shares, and that financially support their hospitals. This paper investigates two potential mechanisms through which hospital concentration may increase tax revenues within a city—specifically, the effect of concentration on changes in nonprofit or for-profit hospital ownership and the effect of concentration on capital investments— failing to find strong supporting evidence for either. Beyond hospital concentration’s role in healthcare price growth across the country, this paper may provide a starting point for further investigation into the impact of hospital mergers and concentration on city governments and other actors.