• Sung J Choi and M Eric Johnson.
• Department of Health Management and Informatics, University of Central Florida, 4364 Scorpius St, Orlando, FL 32816. Email: sung.choi@ucf.edu.
• Am J Manag Care. 2019 Jan 1; 25 (1): e14-e20.

ObjectivesTo estimate the relationship between data breaches and hospital advertising expenditures.Study DesignObservational data on hospital expenditures were analyzed using a propensity score-matched regression. The regression was specified as a generalized linear model using a gamma distribution and log link.MethodsThe study sample included Medicare hospitals captured by a survey of traditional media outlets. Hospitals included were nonfederal acute care inpatient hospitals from 2011 to 2014. Voicetrak provided data on hospital advertising expenditures. The Healthcare Cost Report Information System provided data on hospital characteristics and financial variables. Study groups were matched using observable characteristics, such as revenue, number of beds, discharges, ownership, and teaching status. The study excluded hospitals in Maryland and the US territories for financial reporting consistency. Data breaches included theft, loss, unauthorized access/disclosure, improper disposal, and hacking. Advertising expenditures were collected from media outlets including television, radio, newspapers and business journals, and local magazines in a city/metropolitan area.ResultsBreached hospitals (n = 72) were more likely to be large, teaching, and urban hospitals relative to the control group (unweighted n = 915). A data breach was associated with a 64% (95% CI, 7.2%-252%; P = .023) increase in annual advertising expenditures, holding observable characteristics constant.ConclusionsBreached hospitals were associated with significantly higher advertising expenditures in the 2 years after the breach. Efforts to repair the hospital's image and minimize patient loss to competitors are potential drivers of the increased spending. Advertising costs subsequent to a breach are another cost to the healthcare system that could be avoided with better data security.

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