Estes C L, Swan J H
Institute for Health and Aging, University of California, San Francisco 94143-0612.
Milbank Q. 1994;72(2):277-98.
Home health agency (HHA) access based on organizational and market factors is considered, employing a theoretical model of isomorphism for organizational factors and ecological and economic theories for market factors. Data derive from 1986 and 1987 telephone surveys that randomly sampled 185 HHAs from nine metropolitan areas in five states. Results show that competition limits restrictions on access; for-profit status and system membership increase the likelihood that clients will be refused for financial reasons. Findings support the isomorphism theory that fewer access and other behavioral differences appear within systems: nonprofits and for-profits tend to behave alike within systems, whereas freestanding nonprofits are less likely than their for-profit counterparts to refuse access. Findings for system members may account for some of the problems of legitimacy experienced by nonprofit health care organizations.
基于组织和市场因素的家庭健康机构（HHA）准入情况得到了研究，采用了组织因素的同构理论模型以及市场因素的生态和经济理论。数据来源于1986年和1987年的电话调查，这些调查从五个州的九个大都市地区随机抽取了185家家庭健康机构。结果表明，竞争限制了准入限制；营利性地位和系统成员身份增加了客户因财务原因被拒绝的可能性。研究结果支持同构理论，即在系统内准入和其他行为差异较少：非营利组织和营利组织在系统内的行为往往相似，而独立的非营利组织比营利组织更不可能拒绝准入。系统成员的研究结果可能解释了非营利性医疗保健组织所经历的一些合法性问题。
