The purpose of this study is to examine the association of managerial incentives and political costs with hospital financial distress, recovery or closure. The Medicare…
The purpose of this study is to examine the association of managerial incentives and political costs with hospital financial distress, recovery or closure. The Medicare Payment Advisory Commission has stated that hospital closures are important for evaluating the distribution of cost, quality and access to healthcare throughout the US. Using Logistic regression, we demonstrate that hospital closure is associated with low occupancy, return on investment, asset turnover, and lack of affiliation with a multihospital system. It is also significantly associated with urban location, teaching programs, high Medicare and Medicaid patient populations, and high debt. Essential access nonprofit hospitals are less likely to close, while this does not affect governmental and for-profit hospitals. Our research hypotheses are supported by these results.
Very little has been published about the effects of hospital closure in terms of the service, financial or management issues of the process. Attempts through a case‐study format to redress the balance and as such represents the reflections of practitioners who have recently undergone the experience of hospital closure and the often neglected issues arising both during and after the process.
An empirical study of 71 hospitals in the United States revealed that strategic factors are highly correlated with a hospital′s financial risk position. Finds strong…
An empirical study of 71 hospitals in the United States revealed that strategic factors are highly correlated with a hospital′s financial risk position. Finds strong statistical evidence that ownership status, location, and level of service affect the hospital′s financial risk position, as measured by the Financial Viability Ratio Index.
In the case of Regina v Tunbridge Wells Health Authority, Ex parte Goodridge and Others, the 24 doctors comprising the General Practitioner Committee of the Tonbridge…
In the case of Regina v Tunbridge Wells Health Authority, Ex parte Goodridge and Others, the 24 doctors comprising the General Practitioner Committee of the Tonbridge Cottage Hospital successfully challenged a decision, taken by the Tunbridge Wells Health Authority on 12th January, 1988, and confirmed on 29th March, 1988, to close the hospital temporarily from 1st April, 1988, in order to accommodate budget costs.
This study has two objectives. First, to predict the outcomes of a public sector downsizing; second to measure effects of downsizing at organizational and…
This study has two objectives. First, to predict the outcomes of a public sector downsizing; second to measure effects of downsizing at organizational and inter‐organizational levels. Primary data to assess the organizational level effects was collected through interviews with senior executives at two of Metro‐Toronto's hospitals. Secondary data, to assess the inter‐organizational effects, was collected from government documents and media reports. Due to the exploratory nature of the study's objectives a case study method was employed. Most institutional downsizing practices aligned with successful outcomes. Procedures involved at the inter‐organizational level aligned with unsuccessful outcomes and negated organizational initiatives. This resulted in an overall alignment with unsuccessful procedures. The implication, based on private sector downsizings, is that the post‐downsized hospital system was more costly and less effective.
Views the closure of a hospital in an unusual manner. Questions the role of health workers as “care in the community” comes to the fore. Raises questions about psychiatric…
Views the closure of a hospital in an unusual manner. Questions the role of health workers as “care in the community” comes to the fore. Raises questions about psychiatric hospitals, people with mental health problems and mental health workers.
The purpose of this chapter is to apply structural functional theory and the concept of “unbundling” to an analysis of the deinstitutionalization and community mental…
The purpose of this chapter is to apply structural functional theory and the concept of “unbundling” to an analysis of the deinstitutionalization and community mental health efforts that have shaped the current mental health services environment.
We examine the original goals of the institutional movement, the arguments supporting it, and the functions of the institutions that were created. We then examine the criticisms of that approach and the success of the subsequent deinstitutionalization process, which attempted to undo this process by recreating the hospitals’ functions in community settings. Finally, we address the question of whether the critical functions of psychiatric institutions have indeed been adequately recreated.
Our overview of outcomes from this process suggests that the unbundling of state hospital functions did not yield an adequate system of care and support, and that the functions of state hospitals, including social control and incapacitation with respect to public displays of deviance were not sufficiently recreated in the community-based settings.
The arguments for the construction of state hospitals, the critiques of those settings, and the current criticism of efforts to replace their functions are eerily similar. Actors involved in the design of mental health services should take into account the functions of existing services and the gaps between them. Consideration of the history of efforts at functional change might also serve this process well.
Change in ownership among U.S. community hospitals has been frequent and, not surprisingly, remains an important issue for both researchers and public policy makers. In…
Change in ownership among U.S. community hospitals has been frequent and, not surprisingly, remains an important issue for both researchers and public policy makers. In the past, investor-owned hospitals were long suspected of pursuing financial over other goals, culminating in several reviews that found few differences between for-profit and nonprofit forms (Gray, 1986; Sloan, 2000; Sloan, Picone, Taylor, & Chou, 2001). Nevertheless, continuing to the present day, several states prohibit investor-ownership of community hospitals. Conversions to investor-ownership are only one of six types of ownership change, however, with relatively less attention paid to the other types (e.g., for-profit to nonprofit, public to nonprofit). This study has two parts. We first review the literature on the various types of ownership conversion among community hospitals. This review includes the rate at which conversions occur over time, the relative frequency in conversions between specific ownership categories and the observed effects of conversion on hospital operations (e.g., strategic direction and decision-making processes) and performance (e.g., access, quality, and cost). Overall, we find that the impact of ownership conversion on the different measures is mixed, with slightly greater evidence for positive effects on hospital efficiency. As one explanation for these findings, we suggest that the impact of ownership conversion on hospital performance may be mediated by changes in the hospital's strategic content and process. Such a hypothesis has not been proposed or examined in the literature. To address this gap, we next study the role of strategic reorientation following hospital conversion in a field study. We conceptualize ownership conversion within a strategic adaptation framework, and then analyze the changes in strategy content and process across sixteen hospitals that have undergone ownership conversions from nonprofit to for-profit, public to for-profit, public to nonprofit, and for-profit to nonprofit. The field study findings delineate the strategic paths and processes implemented by new owners post-conversion. We find remarkable similarity in the content of strategies undertaken but differences in the process of strategic decision making associated with different types of ownership changes. We also find three main performance effects: hospitals change ownership for financial reasons, experience increases in revenues and capital investment post-conversion, and pursue labor force reductions post-conversion. Membership in a multi-hospital system, however, may be a major determinant of both strategy content and decision-making process that is confounded with ownership change. That is, ownership conversion may mask the impact of system membership on a hospital's strategic actions. These findings may explain the pattern of performance effects observed in the literature on ownership conversions.
Knowledge of what makes for quality in adult learning disabilities services does not cascade directly down into grassroots practice. It is instead severely filtered and…
Knowledge of what makes for quality in adult learning disabilities services does not cascade directly down into grassroots practice. It is instead severely filtered and variously diluted through layers of national policy, local strategy and administrative complexity. In the current difficult climate, quality is not obtained without exposure to the strains and stresses inherent in the dynamics of the health and welfare bureaucracies and their attempts at partnership. Following a largely chronological and descriptive account of attempts to change and develop services in the Greater Glasgow area in the mid‐1990s, consideration is given to the effect of these ‘filters’ in the context of the Greater Glasgow Joint Learning Disability Project.