Search results

The COVID-19 pandemic created a broad array of challenges for hospitals. These challenges included restrictions on admissions and procedures, patient surges, rising costs of labor and supplies, and a disparate impact on already disadvantaged populations. Many of these intersecting challenges put pressure on hospitals' finances. There was concern that financial pressure would be particularly acute for hospitals serving vulnerable populations, including safety-net (SN) hospitals and critical access hospitals (CAHs). Using data from hospitals in Washington State, we examined changes in operating margins for SN hospitals, CAHs, and other acute care hospitals in 2020 and 2021. We found that the operating margins for all three categories of hospitals fell from 2019 to 2020, with SNs and CAHs sustaining the largest declines. During 2021, operating margins improved for all three hospital categories but SN operating margins still remained negative. Both changes in revenue and changes in expenses contributed to observed changes in operating margins. Our study is one of the first to describe how the financial effects of COVID-19 differed for SNs, CAHs, and other acute care hospitals over the first two years of the pandemic. Our results highlight the continuing financial vulnerability of SNs and demonstrate how the factors that contribute to profitability can shift over time.

The hospital industry is again experiencing a wave of consolidation as formerly independent hospitals are acquired by multihospital systems. The effects of these consolidations on operating costs and care quality have been researched extensively. However, in addition to these benefits, many hospitals also hope that joining a multihospital system will improve their access to capital. Improved access to capital could be a particularly important benefit for independent, not-for-profit (NFP) hospitals because these hospitals face capital constraints since they lack access to publicly issued equity. Despite being an often-cited benefit of system membership, access to capital has received little attention from researchers. We draw on financial theory to identify several mechanisms through which system membership might improve access to capital for acquired NFP hospitals. We develop and test hypotheses using data from an earlier period of hospital consolidation during which hospitals were even more financially constrained than they are at present. Using propensity score matched control hospitals, we examine changes in leverage that occurred after independent hospitals joined multihospital systems. We find evidence that system membership allows under-leveraged hospitals to increase their debt holdings, suggesting that system membership may help NFP hospitals attain an optimal capital structure.

Although recent public attention has focused on boom-and-bust cycles in industries and financial markets, organizational theorists have made only limited contributions to our understanding of this issue. In this chapter, I argue that a distinctive strategic insight into the mechanisms generating boom-and-bust cycles arises from a focus on entrepreneurial inertia – the lag time exhibited by organizational founders or investors entering a market niche. While popular perceptions of boom-and-bust cycles emphasize the deleterious effect of hasty entrants or overvaluation, I suggest instead that slow, methodical entries into an organizational population or market may pose far greater threats to niche stability. This proposition is explored analytically, considering the development of U.S. medical schools since the mid-18th century.

The underrepresentation of men of color (MOC) in US higher education and the growing disparities in their educational attainment has prompted much concern among policy makers and educators. The objective of this chapter is to address the comparative perspectives on equity and inclusion aim of the book by exploring why MOC are less like to earn a degree. We begin with a review of the contemporary literature on MOC and their academic transition to college in the United States. Next, findings from a longitudinal study that explored the early transitional challenges experienced by this population are presented. Results show the stark differences between high school and college in terms of faculty expectations, autonomous responsibility for academic coursework, and academic demands permeated early academic experiences of a group of MOC. Implications for practitioners are discussed.