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dc.contributor.authorSharma, Arunen
dc.date.accessioned2018-10-13T08:00:23Zen
dc.date.available2018-10-13T08:00:23Zen
dc.date.issued2018-10-12en
dc.identifier.othervt_gsexam:17018en
dc.identifier.urihttp://hdl.handle.net/10919/85362en
dc.description.abstractThis dissertation examines the effects of physician ownership of hospitals on the quality of patient-centric care in the U.S. The health care sector in the U.S. is becoming more aligned with markets and in turn, with consumers’ preferences. In consumer driven service industries, consumer satisfaction is considered a key criterion to judge quality. In the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction surveys, physician-owned hospitals (POHs) get more top 5-Star ratings than other hospitals. However, it is not known whether higher perceived patient satisfaction is because of better inpatient experience or due to better health related outcomes. Ratings also do not clarify variations between specialty and general service POHs. The study compares the quality of care in POHs with that in other major forms of hospitals (corporate-owned, and not-for-profit). The Affordable Care Act (ACA) regulated physician ownership of hospitals due to concerns that physicians’ profit motive might negatively affect the quality of care. This non-experimental study used bivariate and multivariate analyses to examine variation in the quality of care among types of hospitals in 2017 and 2018 using patient satisfaction and clinical outcomes as indicators of quality. This study used two samples, a full and a restricted sample. Full sample compared all POHs (specialty and general service) with other hospitals. Restricted sample included only general service hospitals. Patients in POHs were found to have higher perceived satisfaction, and viewed providers’ practices more favorably in the full sample. In the restricted sample, however, not-for-profit (NFP) hospitals provided relatively better care. Corporate-owned hospitals had lowest patient satisfaction and poorest outcomes. Results indicate POHs are competitive with not-for-profit hospitals on patient satisfaction dimension of quality care. Multivariate analyses suggest that the effects of physician ownership go away when mediation by providers’ practices is considered. NFP hospitals, however, continue to provide better overall value of care. The results do not support reconsideration of the ACA restrictions on POHs. Patient satisfaction may be contingent upon patient-centric practices than type of hospital, but hospital ownership may affect preference for some practices over others. Outcomes may not matter when patients’ perceptions measure quality.en
dc.format.mediumETDen
dc.publisherVirginia Techen
dc.rightsIn Copyrighten
dc.rights.urihttp://rightsstatements.org/vocab/InC/1.0/en
dc.subjectpatient-centric careen
dc.subjectphysician-owned hospitalsen
dc.subjectpatient satisfactionen
dc.subjectpatient outcomesen
dc.subjectvalue of careen
dc.subjectAffordable Care Act section 6001en
dc.subjectconsumer driven health careen
dc.titlePatient-centric care in the U.S. - A comparative study of patient satisfaction and quality care among for-profit physician-owned, corporate-owned, and not-for-profit hospitalsen
dc.typeDissertationen
dc.contributor.departmentGovernment and International Affairsen
dc.description.degreePh. D.en
thesis.degree.namePh. D.en
thesis.degree.leveldoctoralen
thesis.degree.grantorVirginia Polytechnic Institute and State Universityen
thesis.degree.disciplinePublic Administration and Public Affairsen
dc.contributor.committeechairHult, Karen M.en
dc.contributor.committeememberEckerd, Adam M.en
dc.contributor.committeememberRees, Joseph V.en
dc.contributor.committeememberLemaire, Robin Hargroderen
dc.description.abstractgeneralThe health care sector is becoming more closely linked to markets, and consumer experience and satisfaction, like any other consumer services industry due to growing influence of for-profit hospitals and hospital forms. Physician-owned hospitals are a relatively new form of hospitals in the U.S. Along with more traditional not-for-profit and corporate-owned hospitals; physician-owned hospitals compete for patients and patient dollars. Many physician-owned hospitals are specialty and surgical hospitals, in addition to general service hospitals. According to federal government surveys, patients usually perceive medical care provided by physician-owned hospitals to be of superior quality to that of other kinds of hospital. However, physician-owned hospitals are a type of for-profit hospital, and it is not clearly known if general service physician owned hospitals provide similar care as specialty hospitals. This research compared possible quality differences between specialty and general service physician-owned hospitals as well as with corporate-owned and not-for-profit hospitals. The results indicate that patients’ perceptions of quality of care are not consistent for physician-owned specialty and general service hospitals; the higher patient perception ratings for physician-owned hospitals reflect the better performance of specialty hospitals. In comparison with other hospitals, not-for-profit hospitals seem to provide better quality of care (tapped by both patient satisfaction and clinical outcomes) than for-profit hospitals. Corporate-owned hospitals were found to have lowest quality of care. Patients should consider tradeoffs between having better inpatient experiences and better outcomes of care.en


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