Clinical problem-solving: we blew it.
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
B D Gifford
Publications and source records attributed to B D Gifford.
Modeling hospital closure relative to organizational theory: the applicability of ecology theory's environmental determinism and adaptation perspectives.
The writers present a set of hypotheses testing the strength of organizational ecology theory's environmental determinism perspective and the adaptation perspective. Some of these hypotheses are analyzed relative to data on hospital closures in the United States between 1980 and 1985. Initial empirical analyses indicate that environmental determinism's liability of smallness holds relative to hospital closure, but the liability of newness doesn't hold. There are no published accounts where the liability of newness hypothesis hasn't held in research on other industries. The writers speculate that the inverse relationship between a highly changing health care environment and the liability of newness of hospitals may be because newer hospitals are better able to tap into the ongoing changes of the today's turbulent health care delivery environment in the United States. Also, analysis findings show that the environmental interdependence orientation of the adaptation models has some explanatory power in that hospitals with greater community support have much lower closure rates. Consideration of the more organization action oriented framework of the adaptation perspective is called for over the environmental determinism perspective that has been promoted in recent publications. The writers suggest that the more community sponsored a hospital is, the less likely its survival will hinge solely on standard environmental selection criteria, and that the ability of a hospital's administration to correctly adapt to environmental fluctuations is critical, especially in today's turbulent health care delivery environment in the United States.
Health Facilities↗
The effects of corporate restructuring on hospital policymaking.
Hospital corporate restructuring is the segmentation of assets or functions of the hospital into separate corporations. While these functions are almost always legally separated from the hospital, their impact on hospital policymaking may be far more direct. This study examines the effects of corporate restructuring by community hospitals on the structure, composition, and activity of hospital governing boards. In general, we expect that the policymaking function of the hospital will change to adapt to the multicorporate structure implemented under corporate restructuring, as well as the overlapping boards and diversified business responsibilities of the new corporate entity. Specifically, we hypothesize that the hospital board under corporate restructuring will conform more to the "corporate" model found in the business/industrial sector and less to the "philanthropic" model common to most community hospitals to date. Analysis of survey data from 1,037 hospitals undergoing corporate restructuring from 1979-1985 and a comparison group of 1,883 noncorporately restructured hospitals suggests general support for this hypothesis. Implications for health care governance and research are discussed.
Decision Making, Organizational↗
Quality care in a medicaid managed care program: adequacy of prenatal care for teens in Chicago.
This study considers whether obstetricians offer less adequate care to teen prenatal patients in the Healthy Moms, Healthy Kids (HMHK) Medicaid managed care program in Chicago than to non-Medicaid patients. Telephone surveys of obstetricians offices (n = 101) were conducted to determine the content of care in the first prenatal visit. These survey data are combined with demographic and practice background data from The American Medical Association's Physician Master File. Analysis indicates there were no significant differences between groups for receiving: (1) medical histories, (2) physical exam and tests, (3) health promotion counseling, and (4) availability of birthing education materials. Analysis further indicates, however, that teen Medicaid patients are less likely to receive blood tests and some urinalysis-related tests. Not receiving these tests is especially problematic because pregnant teens are more likely to drop out of the prenatal care regimen after their first visit, and teens are more likely to have poorer birth outcomes.
Adolescent↗
New factors in the antitrust regulation of hospital mergers.
This research considers four recent hospital merger attempts in smaller urban areas where a hospital merger clearly presents antitrust concerns, as determined by the Federal Trade Commission (FTC) or Department of Justice (DOJ). These cases provide an understanding of the more compelling strategies that hospitals are using to offset federal antitrust concerns and the increased number of factors that are being used by the FTC and DOJ to analyze a merger's effect on a market. In particular, the cases illustrate how federal agencies' likelihood of contesting a merger is now based on the merging hospitals' ability to provide strong evidence of substantial savings resulting from a merger. Further, evidence indicates that states are taking on increasing authority for the oversight of hospital mergers. This federalism trend suggests that consumer protection for hospital mergers may be enhanced through a combination of federal and state oversight measures.
Antitrust Laws↗