Estes C L, Swan J H, Bergthold L A, Spohn P H
School of Nursing, University of California, San Francisco.
Home Health Care Serv Q. 1992;13(1-2):35-69.
During the 1980s, as the health care industry experienced what observers have dubbed a revolution, the home health industry also experienced its own transformation. Utilizing three organizational theories (neoinstitutional, resource dependency and population ecology), the authors report on a study of a probability sample of 163 home health agencies (HHAs) that were interviewed in 1986 and again in 1987 on the effects of Medicare policy changes including prospective payment (DRGs). This study tests hypotheses concerning the influence of environmental factors (e.g., state policy and characteristics of the local market) and organizational characteristics of the HHA (e.g., tax status and Medicare reliance) in explaining the propensity of HHAs to be (or become) parts of chains and/or multi-facility systems; and to develop particular types of interorganizational relations. The paper discusses the results in the context of public policy changes and the implications for future research and practice.
在20世纪80年代，当医疗保健行业经历了观察家们所称的一场变革时，家庭健康行业也经历了自身的转型。作者运用三种组织理论（新制度理论、资源依赖理论和种群生态理论），报告了一项对163家家庭健康机构（HHAs）概率样本的研究。这些机构在1986年接受了访谈，并于1987年再次就医疗保险政策变化的影响接受访谈，这些变化包括预期支付（诊断相关分组，DRGs）。本研究检验了关于环境因素（如州政策和当地市场特征）以及家庭健康机构的组织特征（如税收状况和对医疗保险的依赖程度）在解释家庭健康机构成为（或变成）连锁机构和/或多机构系统一部分的倾向，以及发展特定类型组织间关系方面影响的假设。本文在公共政策变化的背景下讨论了研究结果以及对未来研究和实践的启示。
