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Volume 54, Number 4
July/August 2009

    Interview with Mark R. Neaman, FACHE, President and Chief Executive Officer, NorthShore University HealthSystem, Kyle L. Grazier

    The Lifelong Iterative Process of Physician Retention , Kenneth H. Cohn, Bruce Bethancourt and Marie Simington
    Helping Hands: Leaders in the Healthcare Sustainability Movement, Walter N. Vernon

    Organ Transplantation: Is the Best Approach a Legalized Market or Altruism? Allison Clemmons
    Consumer-Driven Healthcare Marketing: Using the Web to Get Up Close and Personal, Keila Rooney

    Factors Associated with Hospital Bankruptcies: A Political and Economic Framework
    New Hampshire Critical Access Hospitals: CEO's Report on Ethical Challenges, William Nelson, Marie-Claire Rosenberg, Julie Weiss, and Martha Goodrich

Executive Summary

Factors Associated with Hospital Bankruptcies: A Political and Economic Framework, Amy Yarbrough Landry and Robert J. Landry

Between 2000 and 2006, 42 U.S. acute care hospitals filed for bankruptcy protection under federal law. This article explores hospital bankruptcies over a six-year period. Bankrupt hospitals are compared with their competitors, and hospitals surviving bankruptcy are compared with those organizations that eventually close. Finally, this article identifies nonfinancial factors associated with the filings and categorizes these factors into a political and economic framework.

A literature review of hospital trade publications is used to identify organizations filing for bankruptcy during this period. Data gathered from these resources are used in concert with American Hospital Association data to identify hospital characteristics and publicly available information on factors surrounding hospital bankruptcy filings. Data on the status of hospitals after filing are also collected to determine whether bankruptcy reorganization is successful or results in hospital closure.

Results indicate that 67 percent of hospitals filing for bankruptcy during this time eventually ceased operating. Bankrupt hospitals are smaller than their competitors. They are also less likely to belong to a system and more likely to be investor owned. Factors associated with filing organizations are placed into a political and economic framework derived from Park’s work on municipal bankruptcy filings. Common nonfinancial factors associated with hospital bankruptcies include mismanagement, increased competition, and reimbursement changes.

Executive Summary

New Hampshire Critical Access Hospitals: CEOs’ Report on Ethical Challenges, W illiam Nelson, Marie-Claire Rosenberg, Julie Weiss, and Martha Goodrich

Research into the importance of organizational healthcare ethics has increasingly appeared in healthcare publications. However, to date, few published studies have examined ethical issues from the perspective of healthcare executives, and no empirical study has addressed organizational ethics with an explicit focus on rural hospitals. For our study, we sought to identify the frequency of ethical conflicts occurring within 12 general categories (domains) of administrative activities. Also, we wanted to determine what ethics resources are currently available and whether additional resources would be helpful.

We conducted a structured telephone interview of all 13 chief executive officers (CEOs) of critical access hospitals in New Hampshire. All the CEOs in the study indicated that they encountered ethical conflicts. On average, the three most frequently noted domains were “organizational-professional staff relations,” “reimbursement,” and “clinical care.” All CEOs indicated they would like to have additional ethics resources to address these conflicts.

This study verified that CEOs encounter a broad spectrum of ethical conflicts and need additional ethics resources to address them. Because this study used a small sample of CEOs and represented only one New England state, further ethics-related research in rural healthcare facilities is warranted. Follow-up study would allow for (1) a higher level of generalization of the findings, (2) clarity regarding specific ethical conflicts that rural healthcare executives encounter, and (3) an assessment of ethics resources and training that healthcare executives need to address the ethical conflicts.