Societal Factors and Excess Hospital Factors. An Exploratory Study. Volume II. Final Report

摘要

This exploratory study addresses the potential influences of societal factors on the development and maintenance of excess hospital capacity in metropolitan areas. They include demographic shifts, ethnic and racial composition of a community, racial prejudice, employment concerns, hospital sponsorship, and local coalitions of special interests. Where these forces are strong, they tend to segment metropolitan areas into forceful hospital constituencies that focus demand on, and provide political and financial support for particular institutions without respect to areawide needs. Societal factors are especially apparent in places where population shifts have created increased hospital demand in suburbs, lowered demand in central cities, but have not allowed downward adjustment of capacity in the areas of decreased demand. Where these societal factors are weak, or are confronted by countervailing forces promoting a more cooperative hospital system with wider goals, fewer hospitals serve the same population with fewer beds. Where there are outside pressures to reduce capacity, as with health planning and reimbursement agencies, hospital decision making becomes highly politicized, with specific issues focused by the particular societal factors and constituencies involved in that situation. Hospital complexity and governance also condition the decision making of hospitals and their constituencies. The study included four methods: a literature review, a statistical analysis, preparation of background papers, and site visits to five metropolitan areas.