Does the Provision of High-Technology Health Services Change After the Privatization of Public Hospitals?

Background: Public hospitals hold a key role in providing health care services especially to individuals without health insurance, those who are partially covered by health insurance, and low income population. However, some of these hospitals have converted to private status. The objective of this study was to assess the effect of the ownership conversion of public hospitals into private status on the provision of high-technology health services. Methods: This study used a non-experimental longitudinal design based on merged secondary data from the American Hospital Association annual survey, the Area Health Resources File, and the Local Area Unemployment Statistics [1997–2013]. The dependent variable “high-technology health services” was measured using Saidin index. There were 492 non-federal acute care public hospitals (n=8,335 hospital-year observations) in our sample, of which 104 (21%) converted to private status (75 converted to private not-for-profit and 29 converted to for-profit hospitals). The independent variable “privatization” referred to ownership conversion from public to either private not-for-profit or private for-profit status. We ran two fixed-effects linear regressions to measure the impact of privatization on high-technology services offering. Results: Our key findings suggested that privatization was associated with a decrease in Saidin index (β=−0.74; P=0.016; 95% CI: −1.34 to −1.38). For-profit privatization was associated with a greater decrease in Saidin index (β=−1.29; P=0.024; 95% CI: −2.41 to −0.17), compared with an insignificant decrease for not-for-profit privatization (β=−0.56; P=0.106; 95% CI: −1.25 to 0.12). Conclusions: Given the excessive cost of high-technology health services and the change in the hospitals’ mission after privatization, privatized hospitals tend to reduce the number of high-technology health services they provide

The Presence Of Hospital-Based Palliative Care Programs: A Resource Dependence Perspective

Background: The presence of hospital-based palliative care programs has risen over time in the United States. Nevertheless, organizational and environmental factors that contribute to the presence of hospital-based palliative care programs are unclear. Purpose: The aim of this study was to examine the role of organizational and environmental factors associated with the presence of hospital-based palliative care programs using resource dependence theory. Methodology: Panel data from 2000 to 2009 American Hospital Association Annual Survey and the Area Resource File were used in this study. A random-effect logistic regression was used to analyze the relationship between organizational and environmental factors and the presence of hospital-based palliative care programs. Findings: Hospitals with higher Medicare inpatient days, located in counties with higher Medicare managed penetration, and larger hospitals had greater odds of having a hospital-based palliative care program. Although hospitals in counties that have a higher percentage of individuals 65 years and older, for-profit and government hospitals were less likely to have a hospital-based palliative care program. Practice Implications: Hospitals will vary in the organizational resources available to them, as such, administrators\u27 awareness of the relationship between resources and palliative care programs can help determine the relevance of a program in their hospital

Hospitals\u27 Use of Hospitalists: Implications for Financial Performance

Background: Hospitalists, or physicians specializing in hospital-based practice, have grown significantly since they were first introduced in the United States in the mid-1990s. Prior studies on the impact of hospitalists have focused on costs and length of stay. However, there is dearth of research exploring the relationship between hospitals\u27 use of hospitalists and organizational performance. Purpose: Using a national longitudinal sample of acute care hospitals operating in the United States between 2007 and 2014, this study explores the impact of hospitalists staffing intensity on hospitals\u27 financial performance. Methodology: Data sources for this study included the American Hospital Association Annual Survey, the Area Health Resources File, and the Centers for Medicare & Medicaid Services\u27 costs reports and Case Mix Index files. Data were analyzed using a panel design with facility and year fixed effects regression. Results: Results showed that hospitals that switched from not using hospitalists to using a high hospitalist staffing intensity had both increased patient revenues and higher operating costs per adjusted patient day. However, the higher operating costs from high hospitalist staffing intensity were offset by increased patient revenues, resulting in a marginally significant increase in operating profitability (p \u3c .1). Practice Implications: These findings suggest that the rise in the use of hospitalists may be fueled by financial incentives such as increased revenues and profitability in addition to other drivers of adoption