Multihospital System Affiliation as a Survival Strategy for Rural Hospitals Under the Prospective Payment System

Datos Bibliográficos

ID19431908
AutoresMichael T Halpern (0000-0001-8514-6313, University of Michigan), Jeffrey A Alexander (0000-0003-0872-7936, Department of Health), Mary L Fennell (Department of Public Health)
Año1992
Volumen8
Número2
Páginas93-105
Fecha de publicación1992-03-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaThe Journal of Rural Health (JOURNAL)
Identificadores de la revistaISSN: 0890-765X • E-ISSN: 1748-0361
EditorialWiley (PUBLISHER • GB)
DOI10.1111/j.1748-0361.1992.tb00334.x
PMID10119764
OpenAlexW2147525405
IdiomaEN
Citas recibidas5
Referencias citadas23

The introduction of Medicare's Prospective Payment System (PPS) has disproportionately increased financial pressures on rural hospitals and posed challenges to the survival of these institutions. Increasingly, rural hospitals are seeking strategies that can enhance their chances for survival in a turbulent and hostile environment. This study examined the survival effects of one such strategy, multihospital system affiliation. Specifically, we assessed: (1) whether and how different types of system affiliation in the post‐PPS era affect the likelihood of rural hospital survival; (2) whether particular structural, environmental and hospital performance characteristics moderate the effects of system affiliation on rural hospital survival; and (3) whether systematic selection by rural hospitals into multihospital systems potentially accounts for observed relationships between system affiliation and survival. Proportional hazards analyses indicate that system affiliation with investor‐owned systems significantly reduces survival probabilities of rural hospitals. Affiliation with not‐for‐profit systems or system affiliation under contract management arrangements does not affect survival probabilities of rural hospitals. These general findings are moderated by the effects of hospital ownership and size at the time of affiliation. Finally, study findings indicated that systematic selection by poor performing rural hospitals into investor‐owned systems has occurred in the post‐PPS era. No evidence of selection into not‐for‐profit systems was discovered

Actuarial science · Business · Demographic economics · Economics · Payment · Prospective payment system · Demography · Healthcare Policy and Management · Healthcare Systems and Reforms · Medicine · Primary Care and Health Outcomes · Psychology · Finance