For-Profit Enterprise in Health Care (1986) / Chapter Skim
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10 Hospital Ownership and the Practice of Medicine: Evidence from the Physician's Perspective
10 Hospital Ownership and the Practice of Medicine: Evidence from the Physician's Perspective
Pages 385-401
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From page 385... ...
and attitudinal research program allow us to examine these is sues. This paper describes the data sets used in the analysis, reviews differences in physician characteristics and practice patterns across hospital types, considers the variation in physicians' financial arrangements with hospitals, and examines physicians' attitudes toward forprofit hospitals.
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From page 386... ...
Due to the urban/rural differences and the characteristics of the physicians' primary hospital, the hospitals identified in this analysis do not mirror those in the AHA annual survey. PHYSICIAN CEIARACTERISTICS AND PRACTICE PAI~lERNS An analysis of physician involvement with for-profit hospitals should start by asking the question: Do physicians who have their primary privileges at for-profit hospitals dyer Bom other physicians in any systematic way?
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From page 387... ...
. SOURCE: 1982 AHA Annual Survey of Hospitals and 1984 AMA Socioeconomic Monitoring System Core Survey.
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From page 388... ...
These results suggest Hat forprofit hospitals have not attempted to influ TABLE 3 Distribution of Physicians Between Multihospital Systems and Independent Hospitals by Hospital Ownership Status All Nonfederal Private Type Hospitals Government Not-for-profit For-profit Muldhospital system (%) Independent hospital (%)
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From page 389... ...
SOURCE: 1984 AMA Socioeconomic Monitoring System Core Survey. ence physician practice patterns by placing the physician in an employee's role.
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From page 390... ...
At the other extreme, physicians at independent nonfederal government hospitals are Me most likely to have single admitting privileges. As noted, there has been considerable in TA;B~ 5 Percent of Physicians That Are Board Certified by Hospital Ownership Status and Selected Specialty Breakdowns Multihospital System Independent Private Private Nonfederal Not-for- For- Nonfederal Not-for- For Government profit profit Government Profit profit All physicians 68.7 68.6 61.4 63.8 68.7 63.0 Gener~/family specialty b 43.4 40.8 53-9 43.1 b Medical specialty b 67.3 b 65.0 70.3 b Surgical specialty 76.5 79.3 66.7 73.8 76.4 85.0 Othera 75.9 70.1 67.2 63.2 - 70.0 73.9 NOTE: The variation in board certification by specialty and hospital status was found to be statistically significant using a chi-square test.
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From page 391... ...
The data indicate that there is no significant variation in the weedy number of inpatient visits by hospital type. In addition, while there appears to be variation in the number of Medicare hospital discharges by hospital ownership status, it appears to be consistent with the pattern for total discharges.
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From page 392... ...
392 oo Ct ._ U)
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From page 393... ...
In particular, we find that physicians affiliated with hospitals that are a part 393 of for-profit chains are the least likely to receive payments from their hospital. To control for differences in physician characteristics, we examine differences in financial arrangements using a linear probability model.
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From page 394... ...
SOURCE: 1984 AMA Socioeconomic Monitoring System Core Survey. cannot be drawn from this study due to the small number of physicians in our sample who have Foliations with for-profit hospitals and receive direct payments.
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From page 395... ...
Dependent Variable Direct Independent Direct Lease Payment Variablesa Payment Agreement or Lease Physician Characteristics Specialty Internal medicine0.14*
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From page 396... ...
Unfortunately, data from the Physician Opinion Survey could not be disaggregated in a way that allows us to contrast physicians practicing in MHS hospitals to those in independent hospitals. Question 2 asks physicians to compare the quality of care in for-profit versus not-for-profit hospitals.
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From page 397... ...
This seems to reflect the distribution of physicians across hospital types when viewed from the standpoint of their primary affiliation (Table 11. In an effort to evaluate views on the quality of hospitalcare delivered, the SMS survey asked physicians to compare their primary hospital 397 to other hospitals that they may be familiar with, along certain specific dimensions.
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From page 398... ...
However, data on specific areas of hospital operation (Table 12) produced mixed results with regard to preferences for particular hospital types.
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From page 399... ...
399 ct c)
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From page 400... ...
A second area of research that seems appropriate in light of our findings with regard to financial arrangements is: As for-profit hospitals grow, will new types of financial arrangements between physicians and hospitals develop? Physiciar~lhospital joint ventures and physician ownership of stock in hospital management companies are two such developments that have the potential to alter practice patterns and, therefore, should be studied ~rther.
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From page 401... ...
(1984) The composition of hospital medical staffs.
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