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BACKGROUND: The large number of uninsured individuals in the United States creates negative consequences for those who are uninsured and for those who are covered by health insurance plans. Young adults between the ages of 18 and 24 are the largest uninsured population subgroup. This subgroup warrants analysis. The major aim of this study is to determine why young adults between the ages of 18 and 24 are the largest uninsured population subgroup. METHODS: The present study seeks to determine why young adults between the ages of 18 and 24 are the largest population subgroup that is not covered by private health insurance. Data on perceived health status, perceived need, perceived value, socioeconomic status, gender, and race was obtained from a national sample of 1,340 young adults from the 2005 Medical Expenditure Panel Survey and examined for possible explanatory variables, as well as data on the same variables from a national sample of 1,463 from the 2008 Medical Expenditure Panel Survey. RESULTS: Results of the structural equation model analysis indicate that insurance coverage in the 2005 sample was largely a function of higher socioeconomic status and being a non-minority. Perceived health status, perceived need, perceived value, and gender were not significant predictors of private health insurance coverage in the 2005 sample. However, in the 2008 sample, these indicators changed. Socioeconomic status, minority status, perceived health, perceived need, and perceived value were significant predictors of private health insurance coverage. CONCLUSIONS: The results of this study show that coverage by a private health insurance plan in the 2005 sample was largely a matter of having a higher socioeconomic status and having a non-minority status. In 2008 each of the attitudinal variables (perceived health, perceived value, and perceived need) predicted whether subjects carried private insurance. Our findings suggest that among those sampled, the young adult subgroup between the ages of 18 and 24 does not necessarily represent a unique segment of the population, with behaviors differing from the rest of the sample.

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In large part due to current economic conditions and the political uncertainties of healthcare reform legislation, hospitals need to identify new sources of revenue. Two potentially untapped sources are inbound (international) and domestic (within the United States) medical tourists. This case study uses data from a large, urban healthcare system in the southeastern United States to quantify its potential market opportunities for medical tourism. The data were mined from electronic health records, and descriptive frequency analysis was used to provide a preliminary market assessment. This approach permits healthcare systems to move beyond anecdotal information and assess the relative market potential of their particular geographic area and the diagnostic services they offer for attracting inbound and domestic medical tourists. Implications for healthcare executives and guidance on how they can focus marketing efforts are discussed.

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This study looks at employee information sharing among hospitals, a topic that is underresearched, underreported, and under the radar for most healthcare leaders. We initiated the research under the assumption that executives in healthcare are reluctant to share employment reference information about staff beyond the employee's name, dates of employment, and position held. We believed executives take this precaution because they fear being sued by the employee for defamation. However, not obtaining the necessary and critical information to hire a competent employee can open the potential employer up to a negligence lawsuit if it hires someone who jeopardizes the safety of patients or staff. Hence, the hiring organization faces a double-edged sword: On one side, it cannot get the critical information on a potential applicant from the previous employer due to a culture of "fear in sharing" information; on the other side, if it unwittingly hires a poor or dangerous applicant who threatens safety, it runs the risk of a negligence lawsuit for failure to ascertain information before the hire. Prior studies demonstrate that the likelihood of a successful defamation lawsuit is low and information sharing of factual incidents is unlikely to result in successful lawsuits. Why, then, are healthcare executives unwilling to provide comprehensive references when they should be aware that sustaining a culture of silence increases the potential for hiring a bad employee and seriously jeopardizes the security and safety of patients, other staff, and the public? This article's primary contribution to the literature is to offer the first nationwide study to empirically test the current levels of employee information sharing among hospitals. It is also the first study to focus exclusively on healthcare. Furthermore, this research considers factors that might influence executives in their willingness to share employee reference information. The study reveals that a culture of silence is pervasive among hospitals. Although many hospital executives are reluctant to share information, they tend to overestimate the likelihood of being sued (successfully or otherwise) by previous employees for defamation. In addition, this study shows that some hospital executives share negative information about former employees but may do so off the record.

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The well-anticipated and well-documented demographic shift attributed to ageing of the baby boomer generation will place significant demands upon the health-care industry in the future. Significant resources such as the nurse workforce, will be needed to provide health-care services to this cohort. There is a looming shortage of professional and paraprofessional nurses. This paper evaluates strategies that can be utilized to decrease the rate of the nursing shortage, while retaining the current supply of nurses. Recommendations for solving the nursing shortage problem include enhancing the work environment through fostering open communication, improving technology, nurse empowerment, building long-lasting and fulfilling partnerships, and efficient workplace organization.

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This chapter summarizes the major determinants of health insurance coverage rates among young adults. Socioeconomic status, demographics, actual and perceived health status, perceived value, and perceived need are all examined in order to determine what the literature reveals regarding each variable and how each variable impacts a young adult's decision to purchase health insurance. Results indicate that socioeconomic status, demographics, perceived value, and perceived need were the most significant determinates of health insurance status of young adults. A conceptual framework is also examined and used to illustrate theoretical implications. Managerial implications for marketing health plans to young adults are also addressed. Finally, policy implications concerning the new Patient Protection and Affordable Care Act are addressed.

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The purpose of this research was to explore the effect work environment has on the intent to leave the profession for rural hospital bedside registered nurses (RNs). Subscales of autonomy, control over the practice setting, nurse-physician relationship and organizational support were incorporated into the analysis to determine which aspects of work environment directly affect the intent to leave the profession. An explanatory cross-sectional survey was distributed to 259 direct care bedside RNs employed at a rural system-affiliated hospital in Central Florida between February 2007 and June 2007. Anonymity was assured. A questionnaire containing demographic questions, the Nursing Work Index-Revised and Blau's intent to leave scale was distributed to all direct care nurses. A 32.8% response rate was achieved for a total of 85 complete and usable surveys. Data analysis shows that the work environment in general is negatively related to intent to leave. In addition, each of the four subscales was also negatively related to the intent to leave the profession. The results of this study support several recommendations for practice and education, including the promotion of professional practice environments, fostering inter-departmental relationships, and increasing the managerial training of RN managers.

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As health care organizations expand and move into global markets, they face many leadership challenges, including the difficulty of leading individuals who are geographically dispersed. This article provides global managers with guidelines for leading and motivating individuals or teams from a distance while overcoming the typical challenges that "virtual leaders" and "virtual teams" face: employee isolation, confusion, language barriers, cultural differences, and technological breakdowns. Fortunately, technological advances in communications have provided various methods to accommodate geographically dispersed or "global virtual teams." Health care leaders now have the ability to lead global teams from afar by becoming "virtual leaders" with a responsibility to lead a "virtual team." Three models of globalization presented and discussed are outsourcing of health care services, medical tourism, and telerobotics. These models require global managers to lead virtually, and a positive relationship between the virtual leader and the virtual team member is vital in the success of global health care organizations.

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BACKGROUND: Volunteers have been present in health care settings for centuries. However, there is little empirical evidence regarding the impact that volunteers make on hospital performance. Since the 1990s, hospitals in the United States have had a great deal of pressure to produce high-quality care at minimum expense. These pressures have enhanced the benefits of using volunteers in a hospital setting. PURPOSE: This study utilized multiple regression analysis to explore the impact of the use of volunteers and the level of professionalism of volunteer programs on cost effectiveness and patient satisfaction in hospitals. METHODOLOGY/APPROACH: Hospitals throughout the state of Florida were invited to participate in the study by completing a brief questionnaire about their volunteer programs. Performance indicators of volunteer cost savings and patient satisfaction scores for 50 Florida hospitals were analyzed using data sets from the American Hospital Association and Agency for Health Care Administration along with data obtained from a questionnaire. FINDINGS: Results indicate that the use of volunteers offers significant cost savings to hospitals and enhances patient satisfaction scores. DISCUSSION: Larger volunteer programs appear to enhance patient satisfaction while containing costs. Future research opportunities related to the impact of volunteers and volunteer professionalism on other hospital performance measures are suggested.

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Violence in the health care workplace is occurring in a covert fashion; it is occurring at the patient bedside. However, data on workplace violence tend to be underreported and relatively scarce. This article identifies and examines the phenomenon of unreported and underreported workplace violence against nursing staff that is virtually hidden. Health care executives need to be attuned to this type of violence because it may significantly affect their ability to recruit and retain nursing staff. This article provides a synthesis of literature and data from health services administration and nursing and human resources, as well as the experience of the first author. Workplace violence in health care is a critical issue that must be addressed from legal, financial, ethical, and human resources management perspectives. It is a problem for staff providing direct care services to patients with Alzheimer disease. This article suggests strategies and offers a framework for meeting the challenges of managing hidden workplace violence. In addition to the more discrete consequences of violence including physical injury, physical disability, trauma, or even death, the complementary organizational effects call for thoughtful managerial planning and critical thinking. Guidelines for preventing and addressing workplace violence in health care organizations are also published by the Occupational Safety and Health Administration.

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This exploratory survey examines the relationship between selected dimensions of spirituality and self-perceived effective leadership practices of health-care managers. Kouzes and Posner's Leadership Practices Inventory and Beazley's Spiritual Assessment Scale were administered to a sample of health-care managers. Significant statistical relationships were found between and among the dimensions of both subscales. Analysis of variance revealed a statistically significant difference in three effective leadership practices by 'more spiritual than non-spiritual' managers. The confirmatory factor analysis of our theory-based model revealed a moderately positive correlation between spirituality and leadership (r = 0.50). The paper concludes with a conceptual theory postulating a rationale for the relationship between spirituality and effective leadership.

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Among 10,384 rural Colorado female patients who received MDC 14 (obstetric services) from 2000 to 2003, 6,615 (63.7%) were admitted to their local rural hospitals; 1,654 (15.9%) were admitted to other rural hospitals; and 2,115 (20.4%) traveled to urban hospitals for inpatient services. This study is to examine how network participation, service scopes, and market competition influences rural women's choice of hospital for their obstetric care. A conditional logistic regression analysis was used. The network participation (p < 0.01), the number of services offered (p < 0.05), and the hospital market competition had a positive and significant relationship with patients' choice to receive obstetric care. That is, rural patients prefer to receive care from a hospital that participates in a network, that provides more number of services, and that has a greater market share (i.e., a lower level of market competition) in their locality. Rural hospitals could actively increase their competitiveness and market share by increasing the number of health care services provided and seeking to network with other hospitals.

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Doctoral education is gaining increasing attention as new programs proliferate and enrollment grows. Presently there is no standardization of degrees programs, limited aggregated information about health administration education doctoral programs, and an absence of national policy. The general, doctoral education literature presents a variety of issues and challenges for doctoral health administration education including data trends, supply and demand for doctoral graduates, credential inflation, attrition and degree completion, organizational efforts to improve doctoral education, and strategies for the future. Following the literature review, survey results for a sub-sample of AUPHA affiliated doctoral programs are presented along with related implications.

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Among health administration programs, doctoral education has been a low priority for decades. Programs which are profitable from an economic perspective tend to be maintained or expanded while less profitable programs tend to be reduced. For a variety of reasons, doctoral programs tend to be viewed as less profitable than other programs. This paper analyses why doctoral programs are a low priority, the symptoms of this low priority, implications for the future of health administration education, and recommendations for enhancing that future.

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In today's competitive health care environment, service excellence is rapidly becoming a major differentiating advantage between health care providers. Too often, senior executives talk about their commitment to a mission statement that extols the virtues of providing world class service to their patients only to undermine those statements with what they do, write, and say. This article presents an exploratory investigation into a new application of an internal mission alignment instrument that seeks to assess the extent to which an organization's internal processes are aligned with its service mission. This instrument was sent to 250 randomly selected employees from all clinical departments of a large southeastern hospital to explore the underlying alignment factors. A factor analysis of the data revealed eight factors that predicted beneficial employee outcomes such as organizational commitment and satisfaction with the job and organization.

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A single institution is not well positioned to manage the process of tissue donations to maximize utility and minimize the costs associated with such transactions. The proposed creation of a 'hub' organization to service the needs and demands associated with tissue procurement and utilization is outlined. The case of Arizona is used as a case study for the proposed model building on existing network in tissue donation and research. The proposed model would consequently be viewed as legitimate by various network stakeholders, including the general public. Finally, the proposed hub-network would be better able to manage the donation, procurement, storage, preservation, distribution, and use of human tissues for all of the potential uses in a single state.

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One of the major issues in achieving optimum levels of performance in health-care markets is to enhance consumer understanding of their health plan choices in order to facilitate the expansion of 'high-value' health plans at the expense of 'low-value' health plans. The Federal government offers employees many choices of health plans and provides large amounts of information on all of these options through (1) comparative written health plan information, (2) information from the health plans themselves, and (3) comparative health plan information on the Internet. The present study examines the degree to which 1722 Federal employees in the Department of Health and Human Services utilized health plan information from the above three sources in making their annual health plan selection. Results indicate that most employees (64%) used at least one information source, with written information from health plans the most common (53%), followed by comparative written information in The Guide (32%) and the Internet (16%). Those employees who regularly search for information prior to making an important purchase, those with a short time in their current plan, those with family coverage, Whites, African-Americans, and men were all more likely to use health plan information to make their annual choice. The Internet was accessed more often by younger and higher paid employees. Implications for policy and future research are discussed.

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Retailers are expected to profoundly affect health care delivery by providing an alternative site for basic medical care. Retail health services are described together with their potential impacts on patient's health care providers and payors. This article concludes with implications for health care executives.

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This paper proposes an innovation in service learning that we identify as e-service learning. By adding the "e" to service learning, we create a service learning model that is dynamic, mediated by technology, and delivered online. This paper begins by examining service learning, which is a distinct learning concept. Service learning furnishes students with opportunities for applied learning through participation in projects and activities in community organizations. The authors then define and conceptualize e-service learning, including the anticipated outcomes of implementation such as enhanced access, quality, and cost effectiveness of healthcare management education. Because e-service learning is mediated by technology, we identify state of the art technologies that support e-service learning activities. In addition, possible e-service learning projects and activities that may be included in healthcare management courses such as finance, human resources, quality, service management/marketing and strategy are identified. Finally, opportunities for future research are suggested.

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OBJECTIVE: To assess the relative validity of patient turnover adjustments and the difference in nurse staffing using measures that adjust for patient turnover and severity versus those that do not. DATA SOURCES: Numbers of registered nurses (RNs), adjusted patient days of care (APDC), length of stay, and patient severity information from acute care general hospitals in Pennsylvania 1994-2001, obtained from the Pennsylvania Department of Health, the American Hospital Association, and the Atlas MediQual system. STUDY DESIGN: After examining the trends in patient turnover and severity and their relationship to RN staffing, we apply two-patient turnover indices, with and without patient severity adjustments, to RN staffing measures, and test the difference between the original and adjusted measures using paired sample t-tests. DATA EXTRACTION METHODS: Data sets were match merged by hospital ID, and patient turnover and severity indices were created, using 1994 as the base year. RN staffing measures were developed using unadjusted APDC, and APDC adjusted for patient turnover and both patient turnover and severity. PRINCIPAL FINDINGS: Patient turnover increased significantly from 1994 to 2001. The difference between RN staffing measures adjusted for patient turnover and severity and those not adjusted was increasingly significant from 1995 onward. Unadjusted RN staffing showed a 1 percent decline over the 8-year-period compared with decreases of from 9 to 26 percent after adjustments. CONCLUSIONS: These results indicate that the assessment of unadjusted RN staffing by RN to patient ratios alone underestimates nursing workload and overstates RN staffing levels. Patient turnover, as well as severity, should be taken into account in staffing assessment and decision making.

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