What drives different treatment choices? Investigation of hospital ownership, system membership and competition

Abstract Background Differences in ownership types have attracted considerable interest because of policy implications. Moreover, competition in hospital markets is promoted to reduce health care spending. However, the effects of system membership and competition on treatment choices of hospitals have not been considered in studying hospital ownership types. We examine the treatment choices of hospitals considering ownership types (not-for-profit, for-profit, and government), system membership, patient insurance status (insured, and uninsured) and hospital competition in the United States. Methods We estimate the probability of according the procedure as the treatment employing logistic regression. We consider all procedures accorded at hospitals, controlling for procedure type and diagnosis as well as relevant patient and hospital characteristics. Competition faced by hospitals is measured using a distance-weighted approach separately for procedural groups. Patient records are obtained from State Inpatient Databases for 11 states and hospital characteristics come from American Hospital Association Annual Survey. Results Not-for-profit hospitals facing low for-profit competition that are nonmembers of hospital systems, act like government hospitals, whereas not-for-profits facing high for-profit competition and system member not-for-profits facing low for-profit competition are not statistically significantly different from their for-profit counterparts in terms of treatment choices. Uninsured patients are on average 7% less likely to be accorded the procedure as the treatment at system member not-for-profit hospitals facing high for-profit competition than insured patients. System member not-for-profit hospitals, which account for over half of the observations in the analysis, are on average 16% more likely to accord the procedure as the treatment when facing high for-profit competition than low-for-profit competition. Conclusions We show that treatment choices of hospitals differ by system membership and the level of for-profit competition faced by the hospitals in addition to hospital ownership type and health insurance status of patients. Our results support that hospital system member not-for-profits and not-for-profits facing high for-profit competition are for-profits in disguise. Therefore, system membership is an important characteristic to consider in addition to market competitiveness when tax exemption of not-for-profits are revisited. Moreover, higher competition may lead to increasing health care costs due to more aggressive treatment choices, which should be taken into account while regulating hospital markets.

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Association of hospital characteristics with outcomes for pediatric neurosurgical accidental trauma patients

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.10.peds20538 ◽

2021 ◽

pp. 1-6

Author(s):

Shenae Samuels ◽

Rebekah Kimball ◽

Vivian Hagerty ◽

Tamar Levene ◽

Howard B. Levene ◽

...

Keyword(s):

General Hospital ◽

Inpatient Mortality ◽

Hospital Ownership ◽

Ownership Type ◽

Accidental Trauma ◽

For Profit ◽

Discharge Disposition ◽

Not For Profit ◽

Children’S Hospitals ◽

Hospital Characteristics

OBJECTIVE In the pediatric population, few studies have examined outcomes for neurosurgical accidental trauma care based on hospital characteristics. The purpose of this study was to explore the relationship between hospital ownership type and children's hospital designation with primary outcomes. METHODS This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project 2006, 2009, and 2012 Kids’ Inpatient Database. Primary outcomes, including inpatient mortality, length of stay (LOS), and favorable discharge disposition, were assessed for all pediatric neurosurgery patients who underwent a neurosurgical procedure and were discharged with a primary diagnosis of accidental traumatic brain injury. RESULTS Private, not-for-profit hospitals (OR 2.08, p = 0.034) and freestanding children's hospitals (OR 2.88, p = 0.004) were predictors of favorable discharge disposition. Private, not-for-profit hospitals were also associated with reduced inpatient mortality (OR 0.34, p = 0.005). A children's unit in a general hospital was associated with a reduction in hospital LOS by almost 2 days (p = 0.004). CONCLUSIONS Management at freestanding children's hospitals correlated with more favorable discharge dispositions for pediatric patients with accidental trauma who underwent neurosurgical procedures. Management within a children's unit in a general hospital was also associated with reduced LOS. By hospital ownership type, private, not-for-profit hospitals were associated with decreased inpatient mortality and more favorable discharge dispositions.

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Implementation of Wireless “Intelligent” Pump IV Infusion Technology in a Not-for-Profit Academic Hospital Setting

Hospital Pharmacy ◽

10.1310/hpj4209-832 ◽

2007 ◽

Vol 42 (9) ◽

pp. 832-840 ◽

Cited By ~ 16

Author(s):

Lor Siv-Lee ◽

Linda Morgan

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Hospital Setting ◽

The United States ◽

Main Campus ◽

For Profit ◽

Not For Profit ◽

Drug Concentrations ◽

Wireless Infrastructure ◽

Infusion System

Purpose This paper describes the implementation of wireless “intelligent” pump intravenous (IV) infusion technology in a not-for-profit academic, multicampus hospital system in the United States. Methods The process of implementing a novel infusion system in a multicampus health care institution (main campus plus three satellite campuses) is described. Details are provided regarding the timelines involved, the process for the development of the drug libraries, and the initial implementation within and across campuses. Results In early 2004, with the end of the device purchase contract period nearing, a multidisciplinary committee evaluated potential IV infusion pumps for hospital use. In April 2004, the committee selected the Plum A+ infusion system with Hospira MedNet software and wireless capabilities (Hospira Inc., Lake Forest, IL). Implementation of the single-channel IV infusion system took place July through October 2005 following installation of the wireless infrastructure throughout the multicampus facility. Implementation occurred in July, one campus at a time; the three smaller satellite campuses went “live” before the main campus. Implementation of the triple-channel IV infusion system took place in March 2006 when the wireless infrastructure was completed and fully functional throughout the campuses, software was upgraded, and drug library revisions were completed and uploaded. Conclusion “Intelligent” pump technology provided a framework to standardize drug concentrations used in the intensive care units. Implementation occurred transparently without any compromise of patient care. Many lessons were learned during implementation that explained the initial suboptimal compliance with safety software use. In response, the committee developed strategies to increase software utilization rates, which resulted in improved acceptance by nursing staff and steadily improving compliance rates. Wireless technology has supported remote device management, prospective monitoring, the avoidance of medication error, and the timely education of health care professionals regarding potential medication errors.

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Hospital Religious Affiliation and Outcomes for High-Risk Infants

Medical Care Research and Review ◽

10.1177/1077558711432156 ◽

2011 ◽

Vol 69 (3) ◽

pp. 316-338 ◽

Cited By ~ 1

Author(s):

Melissa M. Garrido ◽

Kirk C. Allison ◽

Mark J. Bergeron ◽

Bryan Dowd

Keyword(s):

Health Care ◽

Religious Affiliation ◽

Perinatal Outcomes ◽

Extremely Low Birth Weight ◽

American Hospital ◽

American Hospital Association ◽

For Profit ◽

Annual Survey ◽

Not For Profit ◽

Organizational Affiliation

The effect of hospital organizational affiliation on perinatal outcomes is unknown. Using the 2004 American Hospital Association Annual Survey and Healthcare Cost and Utilization Project State Inpatient Databases, the authors examined relationships among organizational affiliation, equipment and service availability and provision, and in-hospital mortality for 5,133 infants across five states born with very low and extremely low birth weight and congenital anomalies. In adjusted bivariate probit selection models, the authors found that government hospitals had significantly higher mortality rates than not-for-profit nonreligious hospitals. Mortality differences among other types of affiliation (Catholic, not-for-profit religious, not-for-profit nonreligious, and for-profit) were not statistically significant. This is encouraging as health care reform efforts call for providers at facilities with different institutional values to coordinate care across facilities. Although there are anecdotes of facility religious affiliation being related to health care decisions, the authors did not find evidence of these relationships in their data.

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Integration of mental health care in private not-for-profit health centres in Guinea, West Africa: a systemic entry point towards the delivery of more patient-centred care?

10.21203/rs.2.12794/v1 ◽

2019 ◽

Author(s):

Abdoulaye Sow ◽

Jeroen De Man ◽

Myriam De Spiegelaere ◽

Veerle Vanlerberghe ◽

Bart Criel

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Patient Participation ◽

Care Providers ◽

Patient Centred Care ◽

For Profit ◽

Not For Profit ◽

Health Centres ◽

Care Package

Abstract Abstract Background Patient-centred care is an essential component of quality of health care. We hypothesize that integration of a mental health care package into versatile first-line health care services can strengthen patient participation, an important dimension of patient-centred care. The objective of this study is to analyse whether consultations conducted by providers in facilities that integrated mental health care score higher in terms of patient participation. Methods This study was conducted in Guinea in 12 not-for-profit health centres, 4 of which had integrated a mental health care package (MH+) and 8 had not (MH-). The study involved 450 general curative consultations (175 in MH+ and 275 in MH- centres), conducted by 18 care providers (7 in MH+ and 11 in MH- centres). Patients were interviewed after the consultation on how they perceived their involvement in the consultation, using the Patient Participation Scale (PPS). The providers completed a self-administered questionnaire on their perception of patient’s involvement in the consultation. We compared scores of the PPS between MH+ and MH- facilities and between patients and providers. Results The mean PPS score was 24.21 and 22.54 in MH+ and MH- health centres, respectively. Participation scores depended on both care providers and the health centres they work in and ranged from 19.12 to 26.96 (p <0.001) for providers and from 20.49 to 26.96 (p <0.001) for the health centres. When adjusting for health providers and the duration of consultation, the patients consulting an MH+ centre were scoring higher on patient participation score than the ones of an MH- centre (adjusted odds ratio of 4.06 with a 95% CI of 1.17-14.10, p = 0.03). All care providers agreed they understood the patients' concerns, and patients shared this view. All patients agreed they wanted to be involved in the decision-making concerning their treatment; providers, however, were reluctant to do so. Conclusion Integrating a mental health care package into versatile first-line health services can promote more positive attitudes of care provider-patient interactions, even though this process by its own is not sufficient.

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Ownership and Exit Behavior: Evidence from the Home Health Care Market

The B E Journal of Economic Analysis & Policy ◽

10.1515/bejeap-2014-0044 ◽

2016 ◽

Vol 16 (1) ◽

pp. 289-320 ◽

Cited By ~ 1

Author(s):

Chiara Orsini

Keyword(s):

Health Care ◽

Home Health Care ◽

Capital Investment ◽

Home Health ◽

Health Care Market ◽

For Profit ◽

Not For Profit ◽

Quasi Experimental ◽

The Law ◽

Exit Behavior

Abstract In the US health care system a high fraction of suppliers are not-for-profit companies. Some argue that non-profits are “for-profits in disguise” and I test this proposition in a quasi-experimental way by examining the exit behavior of home health care firms after a legislative change considerably reduced reimbursed visits per patient. The change allows me to construct a cross provider measure of restriction in reimbursement and to use this measure and time-series variation due to the passage of the law in my estimates. I find that exits among for-profit firms are higher than those of not-for-profit firms, rejecting the null that these sectors responded to the legislation in similar ways. In addition, my results expand the view that “not-for-profit” firms are a form of “trapped capital.” There is little capital investment in the home health care market, so the higher exit rates of for-profit firms after the law change indicate the possible role of labor inputs in generating differences in exit behavior across sectors.

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For-profit hospital ownership status and use of brachytherapy after breast-conserving surgery.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.6511 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 6511-6511

Author(s):

Sounok Sen ◽

Pamela R. Soulos ◽

Jeph Herrin ◽

Kenneth B Roberts ◽

James B. Yu ◽

...

Keyword(s):

Breast Cancer ◽

Breast Conserving Surgery ◽

Whole Breast Irradiation ◽

Medicare Beneficiaries ◽

Breast Irradiation ◽

Hospital Ownership ◽

For Profit ◽

Not For Profit ◽

Ownership Status ◽

To Receive

6511 Background: Because the benefits of adjuvant radiation therapy (RT) for breast cancer decrease with increasing age, the use of newer and more expensive RT modalities such as brachytherapy in the treatment of older women has been questioned. In particular, patients and policy makers may be concerned that for-profit hospitals might be more likely to use therapies with higher reimbursements. Among both younger and older Medicare beneficiaries with breast cancer, we examined whether hospital ownership status is associated with use of adjuvant brachytherapy. Methods: Using the Centers for Medicare and Medicaid Services Chronic Condition Warehouse database, we conducted a retrospective study of female Medicare beneficiaries aged 66-94 years old receiving breast-conserving surgery for invasive breast cancer in 2008 and 2009. We assessed the relationship between hospital ownership and receipt of brachytherapy, as well as overall RT (i.e. brachytherapy or whole breast irradiation) using hierarchical generalized linear models. Results: The sample consisted of 35,118 women, 8.0% of whom had undergone surgery at for-profit hospitals.Among patients who received RT, those who underwent surgery at for-profit hospitals were significantly more likely to receive brachytherapy (20.2%) than patients treated at not-for-profit hospitals (15.2%; OR for profit vs. not-for profit: 1.50; 95% CI: 1.23-1.84; p<0.001). Among women 66-79 years old, there was no relation between hospital profit status and overall RT use. However, among women age 80-94 years old, receipt of surgery at a for-profit hospital was significantly associated with higher overall RT use (OR: 1.22; 95% CI: 1.03-1.45, p=0.03) and brachytherapy use (OR: 1.66; 95% CI: 1.18-2.34, p=0.003), but not whole breast irradiation use (OR: 1.14; 95% CI: 0.96-1.36, p=0.13) Conclusions: Medicare beneficiaries undergoing breast-conserving surgery at for-profit hospitals were more likely to receive brachytherapy, a newer, less proven, and more expensive technology. Among the oldest women, who are least likely to benefit from RT, care at a for-profit hospital was associated with higher overall RT use, with this difference largely driven by the use of brachytherapy.

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