Contextual factors associated with hospitals’ decision to operate freestanding emergency departments
- 1 July 2017
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Health Care Management Review
- Vol. 42 (3), 269-279
- https://doi.org/10.1097/hmr.0000000000000113
Abstract
Background: Freestanding emergency departments (FSEDs) are fast growing entities in health care, delivering emergency care outside of hospitals. Hospitals may benefit in several ways by opening FSEDs. Purpose: The study used the resource dependence theory as a means to analyze the relationship between market and organizational factors and the likelihood of hospitals to operate FSEDs. Methodology: All acute care hospitals in 14 states with FSEDs present during the study period from 2002 to 2011. Data on FSEDs were merged with American Hospital Association Annual Survey, Centers for Medicare and Medicaid Services’ Cost Reports, and Area Resource File data. The outcome variable consists of whether or not the hospital operates an FSED. Independent variables include per capita income, percent population over age of 65 years, primary care and specialist physicians per capita, urban location, change in the unemployment rate, change in the population, change in poverty level, market competition, total satellite and autonomous FSEDs in the market, Medicare-managed care penetration rate, hospital beds, total margin, and system membership. We used logistic regression analysis with state and year fixed effects. Standard errors in the regression were clustered by hospital. Principal Findings: The number of hospitals operating satellite FSEDs increased from 32 (2.33%) in 2002 to 91 (5.76%) hospitals in 2011 among the 14 states included in the study sample. The results support the hypothesis that hospitals located in munificent environments and more competitive environments (presence of other FSEDs) are more likely to operate an FSED. Organizational level factors such as bed size and system membership are associated with a hospital operating an FSED. Practice Implications: The findings may be used by policy makers in developing regulations for hospitals opening FSEDs. Also, study findings of this study may be used by hospitals to make informed decisions when formulating strategies regarding FSEDs.Keywords
This publication has 33 references indexed in Scilit:
- A Profile of Freestanding Emergency Departments in the United States, 2007The Journal of Emergency Medicine, 2012
- Hospitals’ Geographic Expansion In Quest Of Well-Insured Patients: Will The Outcome Be Better Care, More Cost, Or Both?Health Affairs, 2012
- Where Americans Get Acute Care: Increasingly, It’s Not At Their Doctor’s OfficeHealth Affairs, 2010
- Operating environment and USA nursing homes' participation in the subacute care market: a longitudinal analysisHealth Services Management Research, 2009
- Increasing Rates of Emergency Department Visits for Elderly Patients in the United States, 1993 to 2003Annals of Emergency Medicine, 2008
- National Study of the Relation of Primary Care Shortages to Emergency Department UtilizationAcademic Emergency Medicine, 2007
- National Study of the Relation of Primary Care Shortages to Emergency Department UtilizationAcademic Emergency Medicine, 2007
- Horizontal and Vertical Integration‐Diversification in Rural Hospitals: A National Study of Strategic Activity, 1983–1988The Journal of Rural Health, 1993
- Environmental Munificence: A Theoretical AssessmentAcademy of Management Review, 1991
- Multi-Institutional Arrangements in Health Care: Review, Analysis, and a Proposal for Future ResearchAcademy of Management Review, 1982