Multihospital System Affiliation as a Survival Strategy for Rural Hospitals Under the Prospective Payment System
dc.contributor.author | Halpern, Michael T. | en_US |
dc.contributor.author | Alexander, Jeffrey A. | en_US |
dc.contributor.author | Fennell, Mary L. | en_US |
dc.date.accessioned | 2010-06-01T20:30:25Z | |
dc.date.available | 2010-06-01T20:30:25Z | |
dc.date.issued | 1992-03 | en_US |
dc.identifier.citation | Halpern, Michael T.; Alexander, Jeffrey A.; Fennell, Mary L. (1992). "Multihospital System Affiliation as a Survival Strategy for Rural Hospitals Under the Prospective Payment System." The Journal of Rural Health 8(2): 93-105. <http://hdl.handle.net/2027.42/73618> | en_US |
dc.identifier.issn | 0890-765X | en_US |
dc.identifier.issn | 1748-0361 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/73618 | |
dc.identifier.uri | http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=10119764&dopt=citation | en_US |
dc.description.abstract | 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. | en_US |
dc.format.extent | 1314523 bytes | |
dc.format.extent | 3109 bytes | |
dc.format.mimetype | application/pdf | |
dc.format.mimetype | text/plain | |
dc.publisher | Blackwell Publishing Ltd | en_US |
dc.rights | 1992 The National Rural Health Association | en_US |
dc.title | Multihospital System Affiliation as a Survival Strategy for Rural Hospitals Under the Prospective Payment System | en_US |
dc.type | Article | en_US |
dc.subject.hlbsecondlevel | Public Health | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.contributor.affiliationum | Halpern is a recent graduate of the University of Michigan's Medical Scientist Training Program, and is currently affiliated with the Department of Public Health Policy and Administration at the University of Michigan in Ann Arbor, MI. His research interests include organizational issues in health services and economic analysis of prevention services. | en_US |
dc.contributor.affiliationum | Alexander is a professor of health services management and policy at the University of Michigan in Ann Arbor, MI. His current research interests include governance of health care organizations, hospital-physician integration, and interorganizational relations. | en_US |
dc.contributor.affiliationother | Fennell is professor of sociology at Pennsylvania State University in University Park, PA. She also serves as editor of the Iournal of Health and Social Behavior. Her research interests include the diffusion of innovation in health care organizations and interorganizational relations among health care organizations. | en_US |
dc.identifier.pmid | 10119764 | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/73618/1/j.1748-0361.1992.tb00334.x.pdf | |
dc.identifier.doi | 10.1111/j.1748-0361.1992.tb00334.x | en_US |
dc.identifier.source | The Journal of Rural Health | en_US |
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dc.owningcollname | Interdisciplinary and Peer-Reviewed |
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