Determinants Of Productivity In Hospital-based Rural Health Clinics A Growth Curve Modeling Approach
Keywords
Rural health clinics -- United States, Rural health services -- United States
Abstract
The Patient Protection and Affordable Care Act of 2010 expanded rural Medicaid and Medicare coverage. However, different vehicles of delivering care (e.g., hospitals, health clinics, etc.) have differing organizational capacity that may or may not enable them to overcome the challenges of expanded provision. Consequently, this research employed structural contingency and organizational performance models to investigate the impact of organizational factors on productivity growth, while recognizing that contextual factors also affect the delivery of care. Latent growth curve modeling was used to study a national panel of 708 U.S. hospitalbased Rural Health Clinics for the years 2005 to 2008. Productivity was measured through dynamic slacks-based data envelopment analyses. Unconditional and conditional linear growth curve models were fitted to data. Findings revealed that 1) hospital-based clinics with higher baseline levels of productivity in 2005 had a slower rate of growth in productivity for the years 2006 to 2008, 2) hospital-based clinics with physicians had significantly higher productivity, 3) hospital-based clinics in urban focused areas had significantly higher productivity, 4) newer hospital-based clinics had significantly higher productivity, and 5) prospective payment system was negatively related to the rate of change in productivity growth. Organizational and contextual factors included in this study significantly explained initial differences in productivity but were unable to explain productivity growth. Future research could improve the study by 1) including additional explanatory variables, such as the use of technology and disease management programs, 2) adjusting productivity measures by case mix measures, and 3) conducting truncated panel data regression with Monte Carlo simulation.
Notes
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Graduation Date
2011
Semester
Summer
Advisor
Wan, Thomas T. H.
Degree
Doctor of Philosophy (Ph.D.)
College
College of Health and Public Affairs
Department
Public Affairs
Format
application/pdf
Identifier
CFE0003912
URL
http://purl.fcla.edu/fcla/etd/CFE0003912
Language
English
Length of Campus-only Access
None
Access Status
Doctoral Dissertation (Open Access)
Subjects
Dissertations, Academic -- Health and Public Affairs, Health and Public Affairs -- Dissertations, Academic
STARS Citation
Agiro, Abiy T., "Determinants Of Productivity In Hospital-based Rural Health Clinics A Growth Curve Modeling Approach" (2011). Electronic Theses and Dissertations. 1893.
https://stars.library.ucf.edu/etd/1893