Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Irvine Hall 210, Athens, OH, 45701, USA.
Department of Social and Public Health, Ohio University, Grover Center W359, Athens, OH, 45701, USA.
BMC Health Serv Res. 2021 Dec 11;21(1):1326. doi: 10.1186/s12913-021-07307-1.
Anchor institutions, by definition, have a long-term presence within their local communities, but it is uncertain as to whether for-profit hospitals meet this definition; most research on anchor institutions to date has been limited to nonprofit organizations such as hospitals and universities. Accordingly, this study aims to determine whether for-profit hospitals are stable enough to fulfill the role of anchor institutions through a long-term presence in communities which may help to stabilize local economies.
This longitudinal study analyzes national, secondary data between 2008 and 2017 compiled from the Dartmouth Atlas of Health Care, the American Hospital Association Annual Survey, and County Health Rankings. We use descriptive statistics to calculate the number of closures and mergers of hospitals of different ownership type, as well as staffing levels. Using logistic regression, we also assessed whether for-profit hospitals had higher odds of closing and merging, controlling for both organization and community factors.
We found for-profit hospitals to be less stable than their public and nonprofit hospital counterparts, experiencing disproportionately more closures and mergers over time, with a multivariable analysis indicating a statistically significant difference. Furthermore, for-profit hospitals have fewer full-time employees relative to their size than hospitals of other ownership types, as well as lower total payroll expenditures.
Study findings suggest that for-profit hospitals operate more efficiently in terms of expenses, but this also may translate into a lower level of economic contributions to the surrounding community through employment and purchasing initiatives. For-profit hospitals may also not have the stability required to serve as long-standing anchor institutions. Future studies should consider whether for-profit hospitals make other types of community investments to offset these deficits and whether policy changes can be employed to encourage anchor activities from local businesses such as hospitals.
根据定义，锚定机构在其当地社区中具有长期存在，但尚不确定营利性医院是否符合这一定义；迄今为止，关于锚定机构的大多数研究都仅限于非营利组织，如医院和大学。因此，本研究旨在通过营利性医院在可能有助于稳定当地经济的社区中的长期存在，确定它们是否足够稳定以履行锚定机构的角色。
这项纵向研究分析了 2008 年至 2017 年期间来自达特茅斯医疗保健地图集、美国医院协会年度调查和县卫生排名的全国二级数据。我们使用描述性统计来计算不同所有制类型医院的关闭和合并数量，以及人员配备水平。使用逻辑回归，我们还评估了营利性医院在关闭和合并方面是否具有更高的可能性，同时控制了组织和社区因素。
我们发现营利性医院不如其公共和非营利医院同行稳定，随着时间的推移经历了不成比例的更多关闭和合并，多变量分析表明存在统计学上的显著差异。此外，营利性医院的全职员工人数相对其规模而言少于其他所有制类型的医院，总工资支出也较低。
研究结果表明，营利性医院在支出方面运作效率更高，但这也可能意味着通过就业和采购计划为周边社区做出的经济贡献水平较低。营利性医院也可能没有作为长期锚定机构所需的稳定性。未来的研究应考虑营利性医院是否进行其他类型的社区投资以弥补这些不足，以及是否可以采取政策变化来鼓励当地企业（如医院）开展锚定活动。
