Presentation on theme: "Hospice Care in Hospital: A Resource Dependence and Institutional Perspective BIOS524 Hsueh-Fen Chen 12/09/03."— Presentation transcript:
Hospice Care in Hospital: A Resource Dependence and Institutional Perspective BIOS524 Hsueh-Fen Chen 12/09/03
Introduction (I) The Importance of this research The demand of hospice care increased Not a high profit service for hospitals Hospices focus on caring; hospitals focus on curing and discharging patients quickly.
Introduction (II) Hospitals face technical environment and institutional environment. Hospitals pursue autonomy and legitimacy.
Research Question What economic and non-economic factors influence hospitals to engage in hospice care?
The Purpose of this Research To understand the dynamics of the underlying organizational behavior. To add the knowledge of macro-level organizational theories.
Literature Review (I) Resource dependence theory: organizations survive dependent upon the extent to which they effectively manage their environmental demands, or acquire and maintain vital resources (Pfeffer and Salancik, 1978). The types of resource are important resource, scarce resource, and resource capacity.
Literature Review (II) Institutional theory: organization’s behaviors shaped by myth and irrationality (Scott, 2002). Organizations compete not just for resources, but for political power and institutional legitimacy. Through isomorphism mechanisms, coercive; mimetic, and normative isomorphism, organizations become legitimate and use their legitimacy to enhance their success and survival(Meyer, & Rowan, 1991; DiMaggio & Powell, 1991).
Theoretical Framework Resource dependency theory Important resource Resource scarcity *Resource capacity -hospital size Institutional theory Coercive pressure Professional pressure *Normative pressure -ownership Hospice adoption
Hypotheses H1: Hospitals with large size are more likely to employ vertical integration in providing hospice service than small hospitals. large hospitals have more resource.
Hypotheses H2: Not-for-profit hospitals are more likely to employ a higher degree of vertical integration in providing hospice service than profit hospitals. Not-for profit hospitals meet the stakeholders’ expectation. For-profit hospital meet the shareholders’ expectation.
Methods Research Design: cross-sectional research. Population: non-government, and non-federal hospitals. Research time frame: 1996-1998. Unit of analysis: hospital. Statistical analysis: descriptive and logistic regression. Statistical software: SAS window 8.2.
Data source & measurement Data source ARF: population & market characteristics AHA: hospital characteristics link: link between AHA & PPS PPS: hospital financial report Measurement: see handout
Result-Descriptive Analysis Table 2. The characteristics of each variables in each year (mean values with standard deviations in parentheseses) variable 1996 (n=785) 1997 (n=838) 1998 (n=903) Hospice 0.31(0.46) 0.31(0.46) 0.31(0.46) Hospital bed 216.83(170.58) 225.61(175.62) 220.04(176.68) Ownership 0.15(0.36) 0.14(0.35) 0.15(0.36) Per capita income 22183.05(5562.71) 22991.82(5702.74) 24793.41(6488.66) Aging population 54541.08 (103738.98) 56339.00(105118.53) 54154.47(101890.99) Unemployment rate 5.30(2.20) 5.08(2.21) 4.57(1.90) Return on equity 2.69(7.55) 2.31(6.68) 2.08(8.34) % of Medicare days 0.58(0.37) 0.58(0.49) 0.56(0.17) Occupancy rate 0.51(0.17) 0.53(0.41) 0.52(0.18) Urban 0.63(0.48) 0.61(0.49) 0.60(0.49) Medical school affiliation 0.23(0.42) 0.21(0.41) 0.21(0.41) Nursing school affiliation 0.06(0.23) 0.06(0.23) 0.05(0.21)
Result-logistic regression Table 3: Logistic regression of hospital adoption of hospice, 1996-1998 (N=2526) Independent variables Coef. Odds Ratio Std. Err. Wald Chi-Sruare. Hospital size.75 2.125.09 69.91*** For-profit hospital -.46.63.16 8.28** Per capita income.38 1.46.34 1.29 Aging population -.21.81.06 12.29* Unemployment rate -.03.97.03 1.12** Return on equity*** -.15 0.86.06 5.83 % of Medicare days.09 1.09.11 0.61 Occupancy rate*** -.18 0.83.24 0.55 Urban -.29.75.14 4.37* Medical school affiliation.19 1.21.12 2.26 Nursing school affiliation -.02.98.19 0.01 _cons -6.04 3.17 3.64 *** : P<0.001; ** : P <0.01; * : p<0.05 -2 Log likelihood=2979.975 chi-Square = 149.8936 Prob > chi2 = 0.0001
Discussion and Implication. The results in this study strongly support these two hypotheses. Size and hospice adoption More resource Not-for proit vs. for profit The expectation of stakeholders vs. of shareholders
Discussion and implication Expected outcome of variables The coefficient of unemployment (-) The coefficient of per capita income (+) The coefficient of Medicare inpatient days (+). The coefficient of occupancy rate (-). The coefficient of urban (-) The coefficient of Medical school affiliation (+)
Discussion and implication Unexpected outcome of variable Aging population (-): People over 65 years might not a good indicator. Return on equity (-): Nursing school affiliation (-)
Limitations and further research Younger aging people and older aging people. The quality of data Extended the research time frame: most hospice adoption before 1996.
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