Health systems: changes in hospital efficiency and profitability.

This study investigates potential changes in hospital performance after health system entry, while differentiating between hospital technical and cost efficiency and hospital profitability. In the first stage we obtained (bootstrapped) data envelopment analysis (DEA) efficiency scores. Then, genetic matching is used as a novel matching procedure in this context along with a difference-in-difference approach within a panel regression framework. With the genetic matching procedure, independent and health system hospitals are matched along a number of environmental and organizational characteristics. The results show that health system entry increases hospital technical and cost efficiency by between 0.6 and 3.4 % in four alternative post-entry periods, indicating that health system entry has not a transitory but rather a permanent effect on hospital efficiency. Regarding hospital profitability, the results reveal an increase in hospital profitability only 1 year after health system entry, and the estimations suggest that this effect is a transitional phenomenon. Overall, health system entry may serve as an appropriate management instrument for decision makers to increase hospital performance.

Cooperation for a competitive position: The impact of hospital cooperation behavior on organizational performance.

BACKGROUND: Several public policy initiatives, particularly those involving managed care, aim to enhance cooperation between partners in the health care sector because it is expected that such cooperation will reduce costs and generate additional revenue. However, empirical evidence regarding the effects of cooperation on hospital performance is scarce, particularly with respect to creating a comprehensive measure of cooperation behavior. PURPOSE: The aim of this study is to investigate the impact of hospital cooperation behavior on organizational performance. We differentiate between horizontal and vertical cooperation using two alternative measures-cooperation depth and cooperation breadth-and include the interaction effects between both cooperation directions. METHODOLOGY: Data are derived from a survey of German hospitals and combined with objective performance information from annual financial statements. Generalized linear regression models are used. FINDINGS: The study findings provide insight into the nature of hospitals' cooperation behavior. In particular, we show that there are negative synergies between horizontal administrative cooperation behavior and vertical cooperation behavior. Whereas the depth and breadth of horizontal administrative cooperation positively affect financial performance (when there is no vertical cooperation), vertical cooperation positively affects financial performance (when there is no horizontal administrative cooperation) only when cooperation is broad (rather than deep). PRACTICAL IMPLICATIONS: Horizontal cooperation is generally more effective than vertical cooperation at improving financial performance. Hospital managers should consider the negative interaction effect when making decisions about whether to recommend a cooperative relationship in a horizontal or vertical direction. In addition, managers should be aware of the limited financial benefit of cooperation behavior.

Extending Miles & Snow's strategy choice typology to the German hospital sector.

Hospitals' strategy choices represent highly relevant factors that affect organizational performance and survival. This study assesses the differences among hospitals' strategic choices. This strategy definition and assessment reflects the typology proposed by Miles and Snow, who distinguish four strategy types: defender, analyzer, prospector, and reactor. Synthesis of empirical evidence from previous studies that have applied Miles and Snow's typology in the hospital sector using various methodological approaches and measures provides hints for industry-specific patterns and avenues for further research. Taking an extended view of strategic choice, the authors conduct an empirical survey of a sample of 178 German hospitals. The authors apply a multi-item measure of the Miles and Snow strategy types in the hospital sector and identify hybrid strategy types that deviate from the four strategy types defined by Miles and Snow. Overall, seven distinct strategy types emerge from this analysis. There exist three distinct hybrid types in particular. Strategy choice is systematically related to hospital size and teaching status but not to ownership and location. The significant variance in performance for the seven different strategy types justifies the distinction between them. The results support the idea of industry-specific strategy choices. Policy makers should analyze the structural context in which hospitals operate and intervene through political and regulatory means.

Who chooses, who uses, who rates: the impact of agency on electronic word-of-mouth about hospitals stays.

BACKGROUND: Patients' agents rather than patients themselves often choose hospitals and rehabilitation centers and evaluate inpatient stays. Thus, online reviews of a hospital may reflect a service experience the patient is not responsible for in two ways. First, a patient may evaluate a hospital that a physician as agent has selected, although he still received the service and is qualified to evaluate it. Second, relatives who may not be directly involved in the inpatient stay may write online reviews, which reflect their own experiences and evaluations. PURPOSE: The study analyzes patient satisfaction data in online hospitals reviews and patients' underlying motives for electronic word-of-mouth according to the type of hospital admission and the perspective of the reviewer. METHODOLOGY: The study uses a sample of 822 reviews from an online platform for hospital reviews and primary data generated by an online survey distributed to the writers of these reviews. FINDINGS: Patients who choose a hospital themselves write more positive online reviews than those with an other-directed choice. Relatives' online reviews more often deal with negative hospital experiences and are more likely to reflect a desire for retaliation. PRACTICE IMPLICATIONS: The study results imply that medical care centers (hospitals and rehabilitation facilities) should pay more attention to agency by focusing on the needs and perceptions of relatives who often act as the critical voice of patients in electronic word-of-mouth behavior.