DO GENERAL, COMMUNITY HOSPITALS COMPETE BY SPECIALIZING IN HIGH VOLUME, HIGH REVENUE-GENERATING SERVICE LINES?

摘要: DO GENERAL, COMMUNITY HOSPITALS COMPETE BY SPECIALIZING IN HIGH VOLUME, REVENUE-GENERATING SERVICE LINES? By Nancy J. Muller, Ph.D. A dissertation submitted in partial fulfillment of the requirements for degree Doctor Philosophy at Virginia Commonwealth University University, 2010 Director: Roice D. Luke, Professor, Department Health Administration Among challenges confronting U.S. healthcare are improved quality and safety, greater efficiencies, increased rivalry among competitors. Against backdrop technological advancements, shifts market dynamics, organizational restructuring, hospitals likely to adopt clinical service line specialization as a competitive strategy. The purpose research was determine if general, community show evidence specializing within nation‘s six highest volume, revenuegenerating lines identify factors correlating with such study used retrospective, non-experimental, correlational design analyze secondary 2003-2007 data throughout Florida, Virginia, Nevada. Simultaneous regression subsequently backward deletion, stepwise modeling applied cross-sectional relationships between descriptive variables markets hospital organizations, well state covariate, five selected measures specialization. Six leading were study: cardiac surgery, cardiology, invasive orthopedics, labor delivery, pulmonary services. Results indeed top lines. There are, however, different characteristics supporting each thus variation from one next. While this is considered exploratory nature, findings suggest that hospital, traditionally full-service provider wide range costly complex services, may be undergoing transformations including This demonstrates usefulness examining separately when assessing Complex differences states exist. no sub-analysis due cluster effect. At least policy issues surface warrant need further investigation: (a) source admission drivers physician referral patterns; (b) potential case studies studying strategies; (c) localized analysis variations by state; (d) level; (e) loss choice access delivery line; (f) size an important variable its influence on strategic choices hospitals.