Search results

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.

This chapter assessed internal and external environmental factors that affect variations in rural hospital profitability with a focus on the impact of the Patient Protection and Affordable Care Act regulations that resulted in the expansion of Medicaid eligibility, as well as four Medicare programs that target rural hospitals. A cross section of 2,114 rural US hospitals operating during 2015 was used. The primary source of data was Medicare Hospital Cost Reports. Ordinary least squares regression with correction for serial correlation, using total margin and operating margin as dependent variables, was employed to ascertain the association between profitability and its correlates.

The mean values for operating margin and total margin were −0.0652 and 0.0259, respectively. Hospital profitability was positively associated with location in a Medicaid expansion state, classification by Medicare as a Critical Access Hospital or Rural Referral Center (total margin only), hospital size, system membership, and occupancy rate. Profitability was negatively associated with average length of stay, government ownership, Medicare and Medicaid share of admissions, teaching status, and unemployment rate.

This chapter found that the Medicaid expansions provided modest help for the financial condition of rural hospitals. However, the estimates for the four targeted Medicare Programs (i.e., Critical Access Hospital, Medicare Dependent, Sole Community Critical Access Hospital, and Rural Referral Center) were either small or not significant (p > 0.10). Therefore, these specially targeted federal programs may have failed to achieve their goals of preserving the financial viability of rural hospitals. This chapter concludes with implications for practice.

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 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 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 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.

The long-term financial stability of hospital systems represents a “grand challenge” in health care. New ownership forms, such as private equity (PE), promise to achieve better financial performance than nonprofit or for-profit systems. In this study, we compare two systems with many similarities, but radically different ownership structures, missions, governance, and merger and acquisition (M&A) strategies. Both were nonprofit, religious systems serving low-income communities – Montefiore Health System and Caritas Christi Health Care.

Montefiore's M&A strategy was to invest in local hospitals and create an integrated regional system, increasing revenues by adding primary doctors and community hospitals as feeders into the system and achieving efficiencies through effective resource allocation across specialized units. Slow and steady timing of acquisitions allowed for organizational learning and balancing of debt and equity. By 2019, it owned 11 hospitals with 40,000 employees and had strong positive financials and low reliance on debt.

By contrast, in 2010, PE firm Cerberus Capital bought out Caritas (renamed Steward Health Care System) and took control of the Board of Directors, who set the system's strategic direction. Cerberus used Steward as a platform for a massive debt-driven acquisition strategy. In 2016, it sold off most of its hospitals’ property for $1.25 billion, leaving hospitals saddled with long-term inflated leases; paid itself almost $500 million in dividends; and used the rest for leveraged buyouts of 27 hospitals in 9 states in 3 years. The rapid, scattershot M&A strategy was designed to create a large corporation that could be sold off in five years for financial gain – not for health care integration. Its debt load exploded, and by 2019, its financials were deeply in the red. Its Massachusetts hospitals were the worst financial performers of any system in the state. Cerberus exited Steward in 2020 in a deal that left its physicians, the new owners, holding the debt.

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 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.