For-Profit Enterprise in Health Care (1986) / Chapter Skim
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11 Physicial Participation in the Administration and Governance of System and Freestanding Hospitals: A Comparison by Type of Ownership
11 Physicial Participation in the Administration and Governance of System and Freestanding Hospitals: A Comparison by Type of Ownership
Pages 402-421
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From page 402... ...
physician participation in hospital management. The primary group under investigation are those hospitals owned or leased by investorowned multihospital systems (IO hospitals)
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ANALYTIC APPROACH Zero-order comparisons among investorowned and other hospital categories were performed using chi-square tests of significance in the case of dichotomous variables, and d~fference-of-means l-tests in the case of continuous, dependent variables. IO hospitals were compared separately to each of the other five hospital categories.
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. Independent Variables Freestanding hospital.71.45 1,469 System characteristics System control Religious nonprofit.12.32 247 Secular nonprofit.03.18 70 Investor-owned.06.24 126 Public.01.07 11 Contract-managed.07.25 144 System size21.0072.28 Hospital characteristics Number of beds190.76179.53 Regional location Northeast.23.42 468 South.26.44 542 Norm Central.32.47 660 West.19.39 397 SMSA sizes Non-SMSA.45.50 929 Under 100,000.02.12 32 100,000-250,000.09.28 178 250,000-500,000.09.29 187 500,000-1 million.08.27 160 1 million-2.5 million.14.35 297 Over 2.5 million.14.34 284 House staff11.6050.14 Dependent Variables Whether M.D.s receive salaries as administrators.16 Whether director of medical education paid.19 Whether chief of staff paid Whether chief executive officer is voting member of governing board Whether M.D.s on governing board of executive committee Whether M
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These results are maintained even after the introduction of controls for system size, hospital size, region, SMSA size, and teaching involvement. It is important to note that these board positions can y some influence insofar as 91 percent of the sample IO hospitals indicated that physician board members had voting privileges on the board (Table 3~.
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Only 2 percent of the IO hospitals in the sample indicated that their physicians held such positions, by far the TABLE 5 Comparison of Hospitals in For-profit Systems win Other Hospital Types: Is the Hospice CEO a Voting Member of the Governing Board?
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It should be noteil, however, that when hospital and environmental variables are held constant, chiefs of staffin IO hospitals are less likely than those in secular nonprofit system hospitals to be compensated. Medical education directors in IO hospitals are less likely than their counterparts in freestanding hospitals and religious system hospitals to be compensated after introducing-~e control variables.
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From page 408... ...
eliminated with the introduction of the control variable set. Summary In summary, IO hospitals, relative to freestanding hospitals, appear to have greater physician representation on hospital governing boards although these physicians are no more or less likely to have voting privileges or to serve on the board executive committee than physicians on freestanding hospital boards.
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pitals on compensation for key medical staff members or the existence of a medical staff committee on cost containment/awareness. However, IO hospitals are less likely than freestanding hospitals to have a medical staEcommittee on long-range planning.
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To the extent that this is true, one might expect to find the better performing IO hospitals moving to involve their physicians somewhat more in the managerial activities of the hos pital, and the better performing voluntary hos pitals moving toward greater involvement of their physicians in the governance and poli cymaking activities of the organization. This kind of"convergence" would be consistent with those who suggest that IO and nonprofit sys tems will become more similar in the fixture.
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* Model Statistics R2 .23 .23 N 2,025 2,025 aSize of standard metropolitan statistical area (SMSA)
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* Model statistics Pseudo R .35 ·35 N 2,067 2,067 aSize of standard metropolitan statistical area (SMSA)
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Freestanding Hospitals _ Investor-Owed Systems Standard Standard VariablesCoefficient ErrorCoefficient Error Freestanding hospital - .17 .24 System characteristics System control Religious nonprofit-.57 .16*
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Hospital characteristics Number of beds (100s) Regional location Northeast South North Central SSISA sizea 1.82 .32 2.67 -2.24 - .15 .05 .23 .36 -.16 .34 .16*
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* Model Statistics Pseudo R .38 .38 N 2,067 2,067 aSize of standard metropolitan statistical area (SMSA)
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* - 5.14 .84 Model Statistics Pseudo R .39 .39 N 2,067 2,067 aSize of standard metropolitan statistical area (SMSA)
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* Model Statistics Pseudo R .51 .51 N 2,067 2,067 aSize of standard metropolitan statistical area (SMSA)
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* 5.75 Model statistics R2 .45 45 N 2,025 2,025 CSize of standard metropolitan statistical area (SMSA)
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* - 2.07 .38 Model statistics Pseudo R .14 .14 N 2,067 2,067 aSize of standard metropolitan statistical area (SMSA)
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Standard Standard Coefficient Error Coefficient Error Freestanding hospital .93 .32 System characteristics System control Religious nonprofit-.04 .16.90 .34 Secular nonprofit.03 .28.96 .40 Investor-owned- .93 .32*
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From page 421... ...
11.4950.04 Dependent Variables Number of M.D.s on governing board 1.96 2.27 Number of medical staff committees 13.44 9.13 aFor dichotomously scored variables. bSize of standard metropolitan statistical area (SMSA)
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