 |
The 130th Annual Meeting of APHA |
|
The 130th Annual Meeting of APHA |
Michael D. Rosko, PhD, Health Administration Department, Widener University, One University Place, Chester, PA 19013, 610-499-4322, michael.d.rosko@widener.edu
This study addresses two questions: 1) how have major teaching hospitals performed during the 1990s and 2) what environmental pressures affected their performance? The study examined 180 urban, major teaching (defined as COTH-members) hospitals during the period 1990-99. For comparative purposes, non-teaching hospitals (n=1,000) and hospitals with smaller teaching programs (n=400) were analyzed. AHA Annual Survey of Hospitals and Medicare Hospital Cost Reports were primary data sources. A comprehensive set of performance measures was analyzed to answer the first question. These included: profitability, cost, output volume, case mix, and efficiency. Univariate and multivariate analyses (fixed and random-effect regressions) were performed. Some analysis included only individual-year binary variables as independent variables, providing an estimate of how the level of each performance variable changed annually and allowed assessment of the short-term impact of the Balanced Budget Act (BBA). Separate analysis was performed for each of the three groups of hospitals. To examine the effect of environmental pressures on hospital performance, explanatory variables were added to the regression model. These variables included HMO market share (HMO%), percentage of hospital discharges with Medicare or Medicaid as source of payment, degree of competition (measured by Herfindahl Index). Analysis indicates that almost all performance and environmental measures changed during the study period. Regression results, using fixed-effects or random-effects models, were similar. The fit of fixed-effects models was strong for most dependent variables (R-squared > 0.85). Estimated coefficients of HMO% were significant (p < 0.05) in most equations. For several measures, the degree of competition or payer mix had a stronger association with performance than HMO%. The results suggest that major teaching hospitals were very responsive to environmental fiscal pressures. For example, during the period 1990-99 major teaching hospitals: reduced length of stay, downsized, shifted care to outpatient settings, increased cost efficiency, and restrained growth of residency-training programs. Results indicate that major teaching hospitals faced increased financial pressures during the 1990s (e.g., HMO penetration doubled and mean operating margin fell from -0.043 to -0.056). Non-teaching hospitals felt similar pressures but of lesser magnitude (e.g., compared to major teaching hospitals, they were located in areas with lower HMO penetration rates and had substantially higher mean operating margins). In many cases, performance measures exhibited a non-linear pattern and changes in trend following the passage of the BBA were detected. The paper concludes with policy implications for graduate medical education.
Learning Objectives:
Keywords: Health Care Managed Care, Cost Issues
Presenting author's disclosure statement:
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.