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Results for “Health Facility Closure”

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At least 19 recordsLinked to original sources
PubMed1994

Hospital closure: an efficiency analysis.

Logistic regression analysis was used to test the hypothesis that market forces have led to recent hospital closures. Specifically, inefficient and underutilized hospitals in competitive markets were hypothesized to be at greater risk for closure. While past studies used crude measures of hospital efficiency to predict closure, this study used data envelopment analysis to construct an efficiency index. Mixed support was found for the market forces hypothesis; however, contrary to expectations, inefficient hospitals were not shown to be at increased risk for closure. In fact, efficiency proved to be a weak, but positive, predictor of closure.

Catchment Area, Health↗
PubMed1991

Closures and mergers of VNA home care agencies: a model for the study of causal factors.

Recent closures and mergers of visiting nurses associations (VNAs) raise some potentially serious questions regarding access to home care for the elderly Medicare and Medicaid populations. While VNAs comprise less than 10 percent of the nation's certified home health agencies, they provide approximately 31 percent of all medicare home care (HCFA, 1989). In March of 1986 there were 524 visiting nurses associations nationally whereas today there remain only 495 (HCFA, 1990). A model identifying potential causes of VNA mortality is presented along with some preliminary results. VNA mortality is defined and measured by the date that Medicare certification is terminated as a result of VNA closure or merger.

Aged↗
PubMed1988

Modeling hospital closure relative to organizational theory: the applicability of ecology theory's environmental determinism and adaptation perspectives.

The writers present a set of hypotheses testing the strength of organizational ecology theory's environmental determinism perspective and the adaptation perspective. Some of these hypotheses are analyzed relative to data on hospital closures in the United States between 1980 and 1985. Initial empirical analyses indicate that environmental determinism's liability of smallness holds relative to hospital closure, but the liability of newness doesn't hold. There are no published accounts where the liability of newness hypothesis hasn't held in research on other industries. The writers speculate that the inverse relationship between a highly changing health care environment and the liability of newness of hospitals may be because newer hospitals are better able to tap into the ongoing changes of the today's turbulent health care delivery environment in the United States. Also, analysis findings show that the environmental interdependence orientation of the adaptation models has some explanatory power in that hospitals with greater community support have much lower closure rates. Consideration of the more organization action oriented framework of the adaptation perspective is called for over the environmental determinism perspective that has been promoted in recent publications. The writers suggest that the more community sponsored a hospital is, the less likely its survival will hinge solely on standard environmental selection criteria, and that the ability of a hospital's administration to correctly adapt to environmental fluctuations is critical, especially in today's turbulent health care delivery environment in the United States.

Health Facilities↗
PubMed1990

The "beds to the west" scheme: the politics and outcomes of the 1982 New South Wales hospital rationalisation programme.

Recent announcements by the NSW Government concerning the closure and relocation of hospital services are reminiscent of similar initiatives in 1982. It is timely that consideration be given to the impact and longer term effectiveness of the "beds to the west" scheme as the earlier redistribution programme became known. A review of the extent to which the programme's objectives were achieved together with a description of the principal management features of the decommissioning process provide significant lessons for today's policy makers.

Attitude of Health Personnel↗
PubMed1997

Closure of an asylum: the Friern study of older people.

This article reports a naturalistic study following the closure of Friern Hospital and the movement of elderly long-stay patients, who in the main suffered from severe dementia, to psychiatric nursing homes and hospital beds. It describes changes in the environments and in the patients' cognition, behaviour and use of medical services. The results suggest that psychiatric nursing homes seem able to care for the majority if patients with severe dementia. Future studies should consider whether long-stay hospital beds may, however, be necessary for those with both psychiatric and physical health needs, where increased contact with health service personnel is essential. Prospective examination of the reasons for breakdown of placements in nursing homes and the differences between those placed in various settings may help future planning of services. Relatives' opinions of the long-stay settings also require study.

Aged↗
PubMed2004

A case report: ethics of a proposed qualitative study of hospital closure in an Australian rural community.

BACKGROUND: The GP and qualitative researcher use similar patient-centred approaches, but their roles are different. Guidelines for conducting GP research in small communities are limited. I planned a qualitative study about hospital closure in a small rural Australian town where I worked. Few studies have researched community reaction to hospital closure and this process of change. METHODS: I used historical analysis to improve external reliability, and purposeful sampling to develop and pre-test a qualitative semi-structured research instrument. Newspaper articles, minutes and tape recordings of public meetings, annual reports from 1991 to 1997, quality assurance data and interviews with two health professionals were analysed in this process. These sources were coded using content and thematic analysis. Ethical issues arose during early stages of planning. Ethical guidelines and bioethics principles were discussed with colleagues and a member of an ethics committee. I validated my findings with three other community members involved in the hospital closure. RESULTS: Themes of a transition, from resistance to change and divisions between key stake holders, to a need to appreciate the benefits of change emerged in coding material from 1991 to 1997. The principle of non-maleficence outweighed the principle of beneficence in this study. Existing health services could be harmed by examining the process of change after spending time and resources to reconcile community differences. Individuals could be harmed as confidentiality in a small community was difficult to maintain, and discussions about sensitive issues could produce adverse public criticism. The autonomy of participants to give informed consent was complicated by the author providing clinical services in the community, raising concerns about patients feeling an obligation to participate. CONCLUSIONS: A justified case for discontinuing this study was made by the researcher on ethical grounds. Use of bioethical principles and community representatives to validate findings was a useful technique to guide decisions in a small rural community. This discussion has application in planning other small community studies.

Data Collection↗
PubMed1999

Analysis of the rationale for, and consequences of, nonprofit and for-profit ownership conversions.

OBJECTIVES: To examine percursors to private hospitals conversion, both from nonprofit status to for-profit status and from for-profit to nonprofit status, as well as the effect of hospital conversions on hospital profitability, efficiency, staffing, and the probability of closure. DATA SOURCES: The Health Care Financing Administration's Medicare Cost Reports and the American Hospital Association's Annual Survey of Hospitals. STUDY DESIGN: Bivariate and multivariate analyses comparing conversion hospitals to nonconversion hospitals over time were conducted. DATA EXTRACTION METHODS: The study sample consisted of all private acute care hospital conversions that occurred from 1989 through 1992. PRINCIPAL FINDINGS: Hospitals that converted had significantly lower profit margins prior to converting than did nonconversion hospitals. This was particularly true for nonprofit to for-profit conversions. After converting, both nonprofit and for-profit hospitals significantly improved their profitability. Nonprofit to for-profit hospital conversions were associated with a decrease in the ratio of staff to patients. No association was found between for-profit to nonprofit conversion and staff-to-patient ratios. The difference seems partially attributed to the fact that nonprofit hospitals that converted had higher staff ratios than the industry average. For-profit to nonprofit hospital conversions were associated with an increase in the ratio of registered nurses to patients and administrators to patients, despite the fact that nonprofit and for-profit hospitals did not differ in these ratios. CONCLUSIONS: The improvement in financial performance following hospital conversions may be a benefit to the community that policymakers want to consider when regulating hospital conversions.

Acute Disease↗
PubMed1987

Inner-city hospital closures/relocations: race, income status, and legal issues.

Hospital closures/relocations are occurring with increasing frequency in the United States and these actions are alleged to have adverse consequences for racial-minorities and low-income individuals. This paper through an examination and review of the literature discusses the reasons why hospitals close/relocate, examines the legal issues and questions that have arisen over decisions leading to hospital closures/relocations and discusses the implications of hospital closures/relocations on the health care of inner-city minorities and low-income individuals. The conclusion suggests that for inner-city indigents hospital closure/relocations means only one thing--a decline in hospital care. If the present trend in hospital closures/relocations continues, a few for-profit hospital chains may have the responsibility for determining community health needs based on what services are most profitable and who will be the recipient of these services.

Economics, Hospital↗
PubMed2002

The determinants of hospital and HMO vertically integrated delivery systems in a competitive health care sector.

As a response to increased competition in the U.S. health care system, there have been a number of structural changes such as substantial increases in the number of hospital closings, horizontal mergers, and vertical combinations. This paper uses logistic regression and ordinary least squares models to attempt to understand why short-term, non-federal hospitals have created vertically integrated systems with HMOs in urban and rural markets during the 1993-1997 period. During this period, 1,917 integrated systems were formed while 1,466 dissolved. The empirical results indicate that the relative buying power of hospitals is a significant determinant of why hospitals would create vertically integrated systems with HMOs. Other variables also have significant effects upon the creation of vertical affiliations both at the individual hospital level and at the market level.

Bed Occupancy↗
PubMed1987

Impact of cuts in acute beds on services for patients.

The current redistribution of resources in the National Health Service will require a reduction in the number of acute beds in many district health authorities. The effect of such a reduction on services for patients was examined. Two hundred and two general medical admissions and 201 general surgical admissions to hospitals in West Lambeth District Health Authority were reviewed retrospectively. The elements considered were the severity of the patient's illness at admission, the scope for reducing the length of stay, the potential for other forms of care, and what types of patients would be denied access at different levels of reductions in the number of beds. Given the assumptions a considerable potential for maintaining levels of service with fewer beds was identified. The finding was, however, that even if all of this potential was realised the cuts in the number of beds that are planned by districts that are losing resources would force real reductions in patient services. This suggests a "trade off." To increase services in districts that are gaining resources, real unmet need may have to be created in districts that are losing resources.

Beds↗