The Impact of Public Hospitals' Privatization on Nurse Staffing

Governors State University, University Park IL

Investigators

Abstract

? DESCRIPTION (provided by applicant): As the providers of last resort, public hospitals operate under more challenging environments than private hospitals. They are the ultimate source of care for patients of low income, the uninsured and the underinsured. They are also the major source of highly specialized unprofitable services such as burn care unit. Yet, public hospitals depend on shrinking public funding. All these factors have converged to create a situation where some governments that own public hospitals have resorted to privatization as a strategy for struggling hospitals to survive. Prior studies suggest that privatization may improve financial performance and enhance efficiency, but it may have negative effects on health care access and quality. One potential explanation for these effects is a change in nurse staffing to create efficiencies; however, little research has examined the impact of privatization on nurse staffing. Adequate nurse staffing is crucial in the provision of safe and high quality care, which are among AHRQ's priorities. The proposed study will examine the impact of public hospitals' privatization on nurse staffing. Using a longitudinal design (1997-2012) and secondary data, the study will address the following specific aims: 1) examine the impact of public hospitals' privatization on nurse staffing, and 2) examine whether privatization to for-profit status is associated with a greater change in nurse staffing compared with privatization to not-for- profit status. Our study sample will consist of all government-owned, non-federal, acute care, general and surgical hospitals in the U.S. in 1997. These hospitals will be followed from year to year until 2012. Using hospital and year fixed-effects generalized least squares regressions, our study will control for organizational and market factors that may be associated with nurse staffing. Our study is innovative in that it will be the first to study the impact of public hospials' privatization on nurse staffing patterns. It will use panel data covering an extended time period (15 years), which enable us to capture temporal trends in privatization and nurse staffing and assess whether the relationships change over time. The study findings will allow policymakers and other stakeholders to better understand nurse staffing structures adopted by privatized hospitals and evaluate whether such changes will affect the delivery of high quality and safe health care. We believe that the findings of our study and their dissemination extend prior studies on public hospitals privatization as well as prior studies on nurse staffing.