The hospital, as centerpiece of the U.S. health care system, has long needed to diversify its service provision, constituting a focus for development of new health care systems. Not all hospitals have changed in the same ways, however. The size of a hospital market should strongly affect change. This paper applies resource dependence theory to consideration of hospital provision of SNF, home health, hospice, and geriatric services. It asks how provision differs by community size and considers various facility-specific factors: tax status, size, revenue sources, and extra-organizational linkages. Data derive from the 1995 American Hospital Association survey, a sample of 4,459 community general hospitals in 50 states and the District of Columbia providing full data on all variables considered. Local communities were divided into four groups, cutting at 25,000, 100,000; and 500,000 population. Logistic regression was used to predict involvement in each service type. Medicaid coverage increased provision of SNF and geriatric care. Otherwise, both Medicare and Medicaid coverage show more negative effects in smaller, more positive effects in larger, communities. Positive effects of hospital size and extra-organizational linkages strengthen with community size. Hypotheses are generally supported; but patterns of prediction are complex and do not always follow from resource dependence theory. The specific nature of services and their resource flows must be accounted for when applying the general theory. Hospital involvement in four types of post-hospital and long-term care services clearly differs systematically by community size, suggesting the importance of this factor when considering hospital involvement in service provision.
Learning Objectives: At the conclusion of this session, participants will be able to: 1. List factors involved in hospital diversification; 2. Describe influences of the size of hospital market areas on diversification; 3. Recognize application of resource dependence theory to hospital diversification
Keywords: Hospitals, Long-Term Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: American Hospital Association (data set)
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.