Wheeler J R, Burkhardt J, Alexander J A, Magnus S A
School of Public Health, Dept. of Health Management and Policy, University of Michigan, Ann Arbor 48109-2029, USA.
Health Serv Res. 1999 Apr;34(1 Pt 1):61-81.
To examine the financial, market, and organizational determinants of hospital diversification into subacute inpatient care by acute care hospitals in order to guide hospital managers in undertaking such diversification efforts.
All nongovernment, general, acute care, community hospitals that were operating during the years 1985 through 1991 (3,986 hospitals in total).
Cross-sectional, time-series data were drawn from the American Hospital Association's (AHA) Annual Survey of Hospitals, the Health Care Financing Administration's (HCFA) Medicare Cost Reports, a latitude and longitude listing for all community hospital addresses, and the Area Resource File (ARF) published in 1992, which provides county level environmental variables.
The study is longitudinal, enabling the specification of temporal patterns in conversion, causal inferences, and the treatment of right-censoring problems. The unit of analysis is the individual hospital.
Significant differences were found in the average level of subacute care offered by investor-owned versus tax-exempt hospitals. After controlling for selection bias, financial performance, risk, size, occupancy, and other variables, IO hospitals offered 31.3 percent less subacute care than did NFP hospitals. Financial performance and risk are predictors of IO hospitals' diversification into subacute care, but not of NFP hospitals' activities in this market. Resource availability appears to expedite expansion into subacute care for both types of hospitals.
Investment criteria and strategy differ between investor-owned and tax-exempt hospitals.
研究急症医院向亚急性住院护理领域多元化发展的财务、市场和组织决定因素，以指导医院管理者开展此类多元化努力。
1985年至1991年期间运营的所有非政府、综合性、急症护理社区医院（共计3986家医院）。
横断面时间序列数据取自美国医院协会（AHA）的年度医院调查、医疗保健财务管理局（HCFA）的医疗保险成本报告、所有社区医院地址的经纬度列表以及1992年发布的区域资源文件（ARF），该文件提供县级环境变量。
本研究为纵向研究，能够确定转型中的时间模式、因果推断以及处理右删失问题。分析单位是个体医院。
投资者所有医院与免税医院提供的亚急性护理平均水平存在显著差异。在控制了选择偏差、财务绩效、风险、规模、床位占用率及其他变量后，投资者所有医院提供的亚急性护理比非营利性医院少31.3%。财务绩效和风险是投资者所有医院向亚急性护理领域多元化发展的预测因素，但不是非营利性医院在该市场活动的预测因素。资源可得性似乎会加速两类医院向亚急性护理领域的扩张。
投资者所有医院和免税医院的投资标准及策略不同。
