Cost versus control: Understanding ownership through outsourcing in hospitals

Dalton, Christina Marsh; Warren, Patrick L.

doi:10.1016/j.jhealeco.2016.02.003

Cited by 18 publications

(14 citation statements)

References 29 publications

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“…Many hospitals worldwide, and in Sweden, are facing economic restrictions (Swedish Association of Local Authorities and Regions (SALAR), 2016; Tan et al, 2012;Dalton and Warren, 2016;Santamaria and Santamaria, 2014) and changes in the leadership landscape. Economic status and leadership influence health care resources (Dalton and Warren, 2016;Kardakis et al, 2014). Staffing rates and teamwork are factors that have been directly linked to patient safety and quality of care (Subriana et al, 2014;Van Sluisveld et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Ward nurses' experiences of the discharge process between intensive care unit and general ward

Kauppi

Proos

Olausson

2018

Nursing in Critical Care

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Section: Discussionmentioning

confidence: 99%

Ward nurses' experiences of the discharge process between intensive care unit and general ward

Kauppi

Proos

Olausson

2018

Nursing in Critical Care

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“…Systems with different types of ownership (eg, public or investor) may have varying missions that are manifested in part through differing approaches to physician integration. 15 For example, systems with public ownership might aim to provide access to essential services to disadvantaged populations by integrating providers who offer those services into their system. Prominent motivations for physicians to join systems include stagnant or declining reimbursements, the rising burdens of running an independent practice, and a desire for better work-life balance.…”

Section: What This Study Addsmentioning

confidence: 99%

Health system integration with physician specialties varies across markets and system types

Machta

Reschovsky

Jones

et al. 2020

Health Services Research

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Objective To examine system integration with physician specialties across markets and the association between local system characteristics and their patterns of physician integration. Data Sources Data come from the AHRQ Compendium of US Health Systems and IQVIA OneKey database. Study Design We examined the change from 2016 to 2018 in the percentage of physicians in systems, focusing on primary care and the 10 most numerous nonhospital‐based specialties across the 382 metropolitan statistical areas (MSAs) in the US. We also categorized systems by ownership, mission, and payment program participation and examined how those characteristics were related to their patterns of physician integration in 2018. Data Collection/Extraction Methods We examined local healthcare markets (MSAs) and the hospitals and physicians that are part of integrated systems that operate in these markets. We characterized markets by hospital and insurer concentration and systems by type of ownership and by whether they have an academic medical center (AMC), a 340B hospital, or accountable care organization. Principal Findings Between 2016 and 2018, system participation increased for primary care and the 10 other physician specialties we examined. In 2018, physicians in specialties associated with lucrative hospital services were the most commonly integrated with systems including hematology‐oncology (57%), cardiology (55%), and general surgery (44%); however, rates varied substantially across markets. For most specialties, high market concentration by insurers and hospital‐systems was associated with lower rates of physician integration. In addition, systems with AMCs and publicly owned systems more commonly affiliated with specialties unrelated to the physicians’ potential contribution to hospital revenue, and investor‐owned systems demonstrated more limited physician integration. Conclusions Variation in physician integration across markets and system characteristics reflects physician and systems’ motivations. These integration strategies are associated with the financial interests of systems and other strategic goals (eg, medical education, and serving low‐income populations).

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“…Little empirical research in the field of health care management has explored sectoral differences in diverse processes and outcomes of health care. Despite recent studies about the difference between public and nonpublic systems of health care [9][10][11][12], they have paid little attention to what characteristics are associated with the sectoral variances in health care outcomes. They have mainly focused on simple sectoral differences, rather than on specific sectoral variances of ownership, control, and evaluation.…”

Section: Expanded Theories On Publicness and Organizational Formmentioning

confidence: 99%

“…On the other hand, a lack of financial accountability allows nonprofit and government hospitals to be less efficient than for-profit hospitals [9]. Ownership status in health care organizations may involve different practices of cost management and control mechanisms in contracting out management [10]. In addition, hospital ownership may influence the type of clinical practice [11] and generate differences in health care like bariatric surgery [12].…”

Section: Expanded Theories On Publicness and Organizational Formmentioning

confidence: 99%

The Equity of Health Care Spending in South Korea: Testing the Impact of Publicness

Youngju¹,

Kim

Jung

2020

IJERPH

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This paper examined the important organizational and managerial factors of publicness for the equity of health care. The extent of organizational publicness was measured with key independent variables such as ownership, evaluation, and accreditation. The dependent variable was measured by three equity indicators for patients under medical care and veterans care: financial inequity, social equity, and overall equity. We analyzed unbalanced panel data with 328 general hospitals between 2008 and 2012. We performed panel analysis with fixed and random effects. Our findings illustrate that government ownership is significantly associated with differences in equity indicators. Government owned hospitals show the better performance for equity than nonprofit and individually owned hospitals do. Compared to nonprofit and individually owned hospitals, government owned hospitals have a higher share of medical payment bills and health care spending for the disadvantaged but a lower proportion of out-of-pocket payment. Government evaluation is also significantly related to better equity performance. There are, however, significantly negative interactions between hospital government ownership and the size of medical payment bills. We found a significant tendency that the more medical payments, the less responsiveness to the equity of health care in government owned hospitals. Future research in hospital performance is required to consider not only sectoral differences but also the negative proclivity of public hospitals that shrink health care services for the poor. Further research is also expected to explore what sectoral identities and behaviors across public, nonprofit, and private hospitals influence the level of equity or inequity in health care.

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Cost versus control: Understanding ownership through outsourcing in hospitals

Cited by 18 publications

References 29 publications

Ward nurses' experiences of the discharge process between intensive care unit and general ward

Ward nurses' experiences of the discharge process between intensive care unit and general ward

Health system integration with physician specialties varies across markets and system types

The Equity of Health Care Spending in South Korea: Testing the Impact of Publicness

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