| VA Medical Centers As A Safety Net In A Changing Urban Environment |
| | Gifford, Blair D. | U. of Colorado, Denver | bgifford@castle.cudenver.edu | 303/556-5866 |
| | Cowper, Diane C. | Hines VA Hospital | cowper@research.hines.med.va.gov | (708)-343-7200 |
| | Manheim, Larry M. | Northwestern U. | lmanheim@merle.acns.nwu.edu | (847)-491-5102 |
| | This research considers whether private hospital closures, which result
primarily as a result of a lowered reimbursement for Medicaid inpatient
services in Illinois (1986), affected the demand for inpatient services at
VA Medical centers in the Chicago area from 1980 to 1990. Over 110,000 VA
inpatient discharges from 244 zip codes in the Chicago are are analyzed.
Analysis indicates that nearby private hospital closures significantly
increased veterans' use of VA inpatient care. This research sends an important
message about the important "safety net" role of public institutions, such
as the VA, and the potential ripple effects from Medicaid and Medicare
reimbusement changes on safety net institutions |
| | Keywords: safety net; hospital closures; VA |
| Radical Change in Alberta Health Care: The Recomposition of an Organizational Field |
| | Reay, Trish | U. of Alberta | preay@gpu.srv.ualberta.ca | 403-487-6121 |
| | Hinings, C. R. | U. of Alberta | chinings@gpu.srv.ualberta.ca | 403-492-2801 |
| | Analysis of government imposed structural changes to the health care field
in Alberta, Canada, shows that cognitive changes by field level actors must
support structural change before an organizational field can recompose as a
stable system. In this paper, we integrate the data analysis of documents
related to the radical health reform initiative in Alberta with our
development of a theoretical framework to explain recomposition of an
organizational field. We find that key actors leading a field level change
initiative must continually demonstrate their capacity for action and
maintain interest dissatisfaction with the status quo in order to
encourage supportive cognitive changes for other key actors. Some powerful
actors may be able to prevent or delay the field from recomposing in a
stable state. |
| | Keywords: change; health restructuring |
| A critical review of market level health care strategy literature, 1991-1998 |
| | Wells, Rebecca | U. of Michigan | rswells@umich.edu | 419-825-1249 |
| | Banaszak-Holl, Jane C. | U. of Michigan | janebh@umich.edu | 734-936-1668 |
| | In this review, we argue that the economic theories that have dominated recent market level health care strategy research need to be complemented by greater use of sociological frameworks. Sociological theory can address three central questions which modern economic theories have tended to slight: (1) how decision makers' preferences are determined; (2) who the decision makers are; and (3) how decision makers' plans are translated into organizational action. In particular, we argue that more fully utilizing models of institutional theory, organizational ecology, social movements, social networks, and internal organizational change will enhance future research in health care market level strategy. Unlike modern economic theories, these five sociological frameworks treat both decision maker utility and change itself as problematic. |
| | Keywords: strategy; sociology; review |