The Privatization of Health Care and Physicians' Perceptions of Access to Hospital Services
Milbank QuarterlyPublished 1 January 1987
Mark Schlesinger, Judy Bentkover, David Blumenthal, Robert Musacchio, Janet Willer
Citations55
SJR quartileQ1
SJR score2.75
SNIP2.03
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
For-profit ownership and price competition are reported to restrict admission for the poor and uninsured; the effects of system affiliation are shown to be more complex.
Abstract
Health care in the United States is increasingly delivered by for-profit providers, by multi-facility corporations, and under conditions of price-based competition. The joint influence of these three trends is examined through data drawn from a 1984 survey of physicians conducted by the American Medical Association. For-profit ownership and price competition are reported to restrict admission for the poor and uninsured; the effects of system affiliation are shown to be more complex. Policy responses to future restrictions on access are discussed.
Keywords
Economics, Econometrics and FinanceHealth Professions
The Journal of FinanceIndustrial Market Structure and Economic Performance.
6,393 Citations1971H. Michael Mann, F. M. Scherer
The American Historical ReviewThe Social Transformation of American Medicine
3,287 Citations1984Judith Walzer Leavitt, Paul Starr
New England Journal of MedicineThe New Medical-Industrial Complex
698 Citations1980Arnold S. Relman
Closer attention from the public and the profession, and careful study, are necessary to ensure that the "medical-industrial complex" puts the interests of the pub...
PubMedPhysician utilization. The state of research about physicians' practice patterns.
301 Citations1985John M. Eisenberg
The Bell Journal of EconomicsThe Effects of Competition and Regulation on Hospital Bed Supply and the Reservation Quality of the Hospital
290 Citations1980Paul L. Joskow
A simple queuing model is used to examine several factors that affect hospital bed supply decisions and the reservation quality of the hospital and indicates that hospital reserve margins vary directly with the extent of interhospital competition and inversely with the intensity of hospital regulation.
The Journal of Human ResourcesPhysician Participation in State Medicaid Programs
245 Citations1978Frank A. Sloan, Janet B. Mitchell +1 more
Results indicate that high fee schedules and low administrative burdens are ways to stimulate physician involvement with Medicaid patients, and lend support to the model of physician behavior proposed.
National Academies Press eBooksFor-Profit Enterprise in Health Care
194 Citations1986Bradford H. Gray
New England Journal of MedicineTransfers to a Public Hospital
187 Citations1986Robert L. Schiff, David Ansell +4 more
New England Journal of MedicineInvestor-Owned and Not-for-Profit Hospitals
173 Citations1983Robert V. Pattison, Hallie M. Katz
PubMedThe role of specialized clinical services in competition among hospitals.
153 Citations1986Harold S. Luft, James C. Robinson +3 more
It is found that the presence of nearby institutions and services increases the availability of most of these services in neighboring hospitals, which supports the hypothesis that competition among hospitals within an open-ended reimbursement environment takes the form of nonprice competition for community-based physicians through the acquisition of expensive clinical facilities.
Economic InquiryHOSPITAL OWNERSHIP AND PERFORMANCE
136 Citations1985Edmund R. Becker, Frank A. Sloan
The authors find that hospital cost is quite similar among alternative ownership forms as is profitability, and the results do not provide much empirical support for standard property rights theory.
New England Journal of MedicineThe Monetarization of Medical Care
105 Citations1984Eli Ginzberg
The evidence of history and economics suggests that a related and more pervasive trend, the monetarization of medical care, has been proceeding apace for the past several decades and dominates the present scene.
Health AffairsMultihospital Systems: Issues and Empirical Findings
103 Citations1984Dan Ermann, Jon R. Gabel
Based on a synthesis of empirical studies, economists Dan Ermann and Jon Gabel of the National Center for Health Services Research challenge many of these conventional judgments about the multihospital systems that have been evolving in recent years.
Medical CareCompetition and Regulation
84 Citations1985Harold S. Luft
There is still much the authors do not know about individual aspects of the medical care system, and no article even attempts a comprehensive discussion of the system.
New England Journal of MedicineOwnership and Mental-Health Services
80 Citations1984Mark Schlesinger, Robert A. Dorwart
It is concluded that ownership affects the organizational behavior of mental-health facilities and that the type of ownership was linked to a number of important aspects of institutional performance.
Health AffairsInvestor-Owned and Not-For-Profit Hospitals: Addressing Some Issues
77 Citations1983Frank A. Sloan, Robert A. Vraciu
The comparative economic performance of for-profit and not-for-profit hospitals has intensified in recent years as these institutions have increasingly come to compete with each other for patients and budgets.
PubMedHospital performance in multihospital systems: a comparative study of system and independent hospitals.
65 Citations1982John Coyne
The results show that system hospitals realize both significantly higher cost and higher productivity levels, except for county-owned facilities which have lower costs and insignificantly different productivity levels.
PubMedThe effects of ownership and system affiliation on the economic performance of hospitals.
53 Citations1985S C Renn, Carl J. Schramm +2 more
Investor-owned chain hospitals charged significantly more, and were more profitable, than all other types of hospitals except freestanding for-profits; there were no differences in productive efficiency that could be attributed to ownership or affiliation.
The Milbank Memorial Fund Quarterly Health and SocietyFalling through the Cracks: Poverty, Insurance Coverage, and Hospital Care for the Poor, 1980 and 1982
52 Citations1984Judith Feder, Jack Hadley +1 more
A prudent short-run approach to modifying charity care is advanced, although the long-run necessity for insuring the uninsured is inevitable.
PubMedRate regulation as a strategy for hospital cost control: evidence from the last decade.
51 Citations1983Frank A. Sloan
Medical CareThe Changing Face of American Health Care
50 Citations1985Dan Ermann, Jon R. Gabel
On July 30, 1965, President Lyndon Johnson signed the Medicare legislation into law, which made no attempt to reorganize the nation's medical care delivery system that remained under private ownership and was composed primarily of solo fee-for-service physicians and independent nonprofit hospitals.
Medical CareProfits Under Pressure
45 Citations1986Mark Schlesinger, David Blumenthal +1 more
For-profit plans have average costs 10% higher than their nonprofit counterparts, primarily due to higher expenses for ambulatory care, and average revenues are also higher in investor-owned HMOs, although this difference is one third the size of the estimated difference in costs.
Journal of Health Politics Policy and LawCross-Subsidies and Payment for Hospital Care
38 Citations1984Frank A. Sloan, Edmund R. Becker
It is found that the differential payment is not justified; that the cost-containment efforts of the dominant payers have reduced total payments to hospitals somewhat, but a substantial amount of cost-shifting remains; and that the savings is in profits, rather than in costs.
Journal of Health Politics Policy and LawThe Push for Reprivatization of Health Care Services in Canada, Britain, and the United States
31 Citations1983Geoffrey R. Weller, Pranlal Manga
It is concluded that the push for reprivatization will exacerbate the problems, and that governments would be better advised to pursue policies that would restructure and redesign the supply side of their health systems.
Health AffairsPreferred Provider Organizations: Performance, Problems, and Promise
29 Citations1985Jon R. Gabel, Dan Ermann
The authors applaud the PPO concept, but express concern over its execution, and feel that PPOs will not share a significant slice of the health care marketplace until greater emphasis is placed on cost control.
PEDIATRICSFull and Limited Medicaid Participation Among Pediatricians
29 Citations1983Stephen M. Davidson, Janet D. Perloff +3 more
Factors found to foster the willingness of pediatricians to participate fully in state Medicaid programs included more competitive levels of reimbursement, minimal delays in reimbursement, and eligibility and benefit policies that minimize interference with the exercise of medical judgment.
PubMedDiversification of health care services: the effects of ownership, environment, and strategy.
28 Citations1987S M Shortell, Ewan Morrison +3 more
Investor-owned hospitals provide as many services involving charity care as not-for-profit system hospitals, although investor-owned system hospitals provide fewer such services than not- for-profit freestanding hospitals.
Medical CareDiffusion of Innovative Health Care Services in the United States
28 Citations1970A D Kaluzny, Jay H. Glasser +2 more
Differential implementation patterns through time are shown to be well developed only for rehabilitation services, and implementation rates approximate the normal diffusion curve.
The Milbank Memorial Fund Quarterly Health and Society"A Poor Sort of Memory": Voluntary Hospitals and Government before the Depression
27 Citations1982Rosemary Stevens
Voluntary hospitals are often presented as private institutions which began as self-sufficient, endowed organizations but which have become inappropriately attuned to the competitive marketplace, largely because of perverse economic and political incentives brought about through recent government regulation.
New England Journal of MedicineAccess to Care and the Evolution of Corporate, for-Profit Medicine
22 Citations1984Donald O. Nutter
Access to health care was the centerpiece of federal health policy and legislation in the 1960s and 1970s, and in the 1980s the public and private sectors are preoccupied with cost containment and an .
PubMedMedicaid program characteristics: effects on health care expenditures and utilization.
12 Citations1985Roland McDevitt, William Buczko +3 more
Relationships between State Medicaid program characteristics and program outputs are analyzed in this statistical report, using 1980 cross-sectional data from a variety of sources to evaluate program changes following the Omnibus Budget Reconciliation Act of 1981 and the 1982 economic recession.
PubMedCare of the poor revisited.
10 Citations1984Kinzer Dm
The author concludes that the trend toward increasing the numbers of for-profit hospitals and preferred provider organizations will only worsen the situation, and that equalizing the charity care burden may best be accomplished in states with regulated systems.
Public Finance QuarterlyState Discretion in Ftderal Categorical Assistance Programs: the Case of Medicaid
9 Citations1984Frank A. Sloan
PubMedClosing unprofitable services: ethical issues and management responses.
9 Citations1988J Summers
A case involving OB is developed to show how ethical and management issues blend into one another and how the institution has met or exceeded its ethical obligations.
PubMedMultihospital systems in the '80s--the new shape of the health care industry.
8 Citations1982Maria Karapelou Brown
Considering the major challenges that face hospitals during the 1980s--reimbursement shortfalls, capital acquisition, replacement of obsolete facilities, and more--it seems most likely that investor-owned and not-for-profit multihospital systems will begin to replace freestanding hospitals as the dominant organizational form in the health care industry.
Medical CarePatterns of Hospital Growth
8 Citations1983Carson W. Bays
It is revealed that population growth has had a negative impact on the market share of profit hospitals over this later period, while income has had no detectable effect.
PubMedAn inventory of U.S. health care data bases.
7 Citations1983Mullner Rm, Byre Cs +1 more
This inventory presents brief descriptions of 144 current (1976-1982) nonbibliographic, computer-readable data bases containing national health care information that have been collected by public and private sector organizations and agencies throughout the United States and that are available to researchers outside the sponsoring organization.