Hospital Behavior Tied To Competition, Closures And Staffing Among Topics In the Fall Issue Of Inquiry Journal

ROCHESTER, NY (11/14/2008)(readMedia)-- Summaries of articles from the latest issue of INQUIRY journal:

"The Effects of Hospital Competition on Inpatient Quality of Care" by Ryan L. Mutter, Herbert S. Wong, and Marsha G. Goldfarb - This study found that hospital competition impacts a number of hospital quality care measures, but the effect differs depending on the quality dimension. Generally, increased competition seems to improve quality for measures that are associated with physician skill, expertise, and decision-making, and also are highly visible to patients and families---measures such as in-hospital stroke mortality and anesthesia complications. However, greater competition appears to reduce quality in other measures---for example, decubitus ulcers or deep vein thrombosis---that patients may not realize depend on hospital infrastructure, staff, and nursing mix. The findings suggest that hospitals may shift resources to enhance quality in one dimension at the expense of another.

"The Price Effect of Hospital Closures," by Vivian Y. Wu - Examining urban hospitals between 1993 and 1998, this analysis found that competing hospitals nearest facilities that closed were best able to improve their bargaining positions with private payers. Rival hospitals could raise prices even more if a large hospital closed in a concentrated market or if the neighborhood saw multiple closures. Overall, there was a 4% one-time, permanent price increase due to hospital closures---a strong effect that the author says has been overlooked previously.

"Hospital Staffing Decisions: Does Financial Performance Matter?" by Mei Zhao, Gloria J. Bazzoli, Jan P. Clement, Richard C. Lindrooth, JoAnn M. Nolin, and Askar S. Chukmaitov - Results of this study, which looked at 1995-2000 data, show that community hospitals with declining financial performance reduced their licensed practical nurse (LPN) staffing, but the impact was mixed for registered nurse (RN) and total full-time equivalent (FTE) staffing. The findings suggest that hospitals may give greater priority to RN staffing because RNs are more highly skilled, and may maintain staffing levels in highly profitable and competitive areas, such as cardiac services. Cutbacks may occur in less skilled jobs and in services that are costly, but not very profitable.

Also in the fall issue:

"New Evidence on the Effects of State Mental Health Mandates," by Susan H. Busch and Colleen I. Barry -- This research found that people working in smaller businesses were more likely to use mental health services after the implementation of state mental health parity laws; use of the services after parity was concentrated among low-income individuals.

"Differences in Breast Cancer Diagnosis and Treatment: Experiences of Insured and Uninsured Women in a Safety-Net Setting" by Cathy J. Bradley, David Neumark, Lisa M. Shickle, and Nicholas Farrell - Focusing on care in a large, urban safety-net system, this analysis reveals that uninsured women, compared to their insured counterparts, were more likely to be diagnosed with advanced breast cancer and to require more extensive treatment; uninsured woman also were more likely to experience delays in starting and completing treatment.

"Does High-Risk Pool Coverage Meet the Needs of People at Risk for Disability?" by Jean P. Hall and Janice M. Moore -- This study assessed the coverage and service use of adults in the Kansas high-risk pool and found many of the enrollees to have more medical conditions than the general population and to be underinsured -- factors that could contribute to transition to the federal disability program.

Other fall features:

"Open Letter to the New U.S. President: Health Care Reform in America" - This letter, penned by seven health care executives, urges President-elect Barack Obama to convene a "Health Care Summit" to start repairing the country's "broken" health care system. (open access article available at http://www.inquiryjournalonline.org/pdfserv/i0046-9580-045-03-0249.pdf )

"Dialogue: Advertising by Nonprofit Health Care Organizations" - This discussion with leaders in the health care field looks at the practices and impacts of advertising in the nonprofit health sector. (open access article available at http://www.inquiryjournalonline.org/pdfserv/i0046-9580-045-03-0256.pdf )

"The View from Here: Using Health Insurance Premiums to Change Health Behaviors" - Editor Alan Monheit looks at the problem of obesity and evaluates use of differing health insurance premiums to motivate changes in weight and other health-related behaviors. (open access article available at http://www.inquiryjournalonline.org/pdfserv/i0046-9580-045-03-0252.pdf )

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INQUIRY, the journal of health care organization, provision, and financing, is a peer-reviewed scholarly publication. Now in its 45th year, it is published quarterly by Excellus Health Plan, Inc. Press releases and article abstracts are available on the Inquiry Web site at www.inquiryjournal.org under "Current Issue Table of Contents."