Doctoral Dissertation Research:Doctoral Dissertation Research: Hospitals' Choices and Environmental Pressures

Case Western Reserve University, Cleveland OH

Investigators

Abstract

Brian Gran Cory E. Cronin Case Western Reserve University This research will study the ways in which environmental pressures affect the choices hospitals make regarding community benefit and business-like practices. Hospitals are important social institutions that play multiple societal roles and inevitably respond to pressures exerted upon them by policy changes, societal expectations, and fiscal realities. Previous research documents the long history of hospitals as centerpieces of their communities, but in recent years, much attention has been paid to efforts of cost control and revenue production and the resulting shift to a more corporate culture within health care organizations. New regulations by the IRS and the passage of the Patient Protection and Affordable Care Act (ACA), however, have brought a renewed focus on the ways in which hospitals contribute to and care for their communities, raising the question of how hospital behaviors have changed in the evolving landscape and what the impacts of these changes might be. This study aims to: 1) understand the ways in which hospital environments (including policy implementation and market characteristics) affect hospital choices surrounding community benefit and business-like practices; 2) identify how these factors affect the presence of hospitals in the market; and 3) explore the ways in which market presence and hospital choices regarding practices affect the well-being of their communities. To accomplish these goals, this longitudinal study will use multi-level analysis to examine data collected by the American Hospital Association, the U.S. Census, and the Dartmouth Health Atlas for the years leading up to and immediately after the passage of the ACA. This research has three potential broader impacts. First, it will contribute to the scholarship surrounding institutional theory and institutional logics in its consideration of community benefit as a central logic to the institution of health care. Second, it will provide to leaders of health care organizations a demonstration of how organizations across the field are making decisions in these areas and how these decisions affect organizational and community outcomes. Third, policy makers may be better able to create guidelines for hospitals surrounding community benefit based on an understanding of outcomes of these practices.