RESUMO
This study applies Porter's model of competitive advantage to the nursing home industry. Discriminant analysis is used to identify organizational and environmental characteristics associated with nursing homes which have demonstrated valued strategic outcomes, and to distinguish the more successful nursing homes from their rivals. The results of the discriminant analysis suggest that nursing homes with superior payer mix outcomes are distinguishable from their less successful rivals in areas associated with a focused generic strategy. The study suggests that nursing homes which are better staffed, of smaller size and lower price are more likely to achieve high levels of self-pay utilization. Independent living units, continuing care retirement communities in particular, are likely to act synergistically with nursing home organizational characteristics to enhance competitive advantage by linking the value chain of the nursing home to that of retirement housing. Nursing homes with higher proportions of Medicare were found to provide a unique product when compared to their rivals. Profit status does not discriminate better self-pay strategic utilization, but for-profit facilities are more likely to pursue a Medicare strategy. Concern was raised that, as nursing homes become more strategically oriented, Medicaid access may become more problematic.
Assuntos
Competição Econômica , Administração Financeira/estatística & dados numéricos , Casas de Saúde/organização & administração , Coleta de Dados , Tamanho das Instituições de Saúde/economia , Tamanho das Instituições de Saúde/estatística & dados numéricos , Medicaid , Medicare , Modelos Organizacionais , Casas de Saúde/classificação , Casas de Saúde/economia , Casas de Saúde/normas , Objetivos Organizacionais , Propriedade , Pennsylvania , Estados UnidosRESUMO
As growth potential in the U.S. market declines and regulatory constraints increase, providers of health-related services may look increasingly to international opportunities as a way to supplement the lost domestic market. In this article, critical factors bearing on the decision to compete in international markets are identified. Existing theories of multinational competition are expanded to provide a framework for analyzing international competition. Applied in the context of the proprietary hospital industry, the critical factors governing both the selection of foreign markets and mode of entry are proposed to be host country receptivity and market growth potential.
Assuntos
Competição Econômica/tendências , Hospitais com Fins Lucrativos/economia , Cooperação Internacional , Sistemas Multi-Institucionais/economia , Austrália , Brasil , Serviços Contratados/economia , Planejamento Hospitalar/tendências , Hospitais com Fins Lucrativos/tendências , Investimentos em Saúde/economia , Malásia , Oriente Médio , Modelos Organizacionais , Sistemas Multi-Institucionais/tendências , Objetivos Organizacionais , Propriedade/economia , Singapura , Reino Unido , Estados UnidosRESUMO
This study examines the extent to which nursing homes adjust staffing and care practices relative to local market conditions. Weighted two-stage least squares regression results suggest that facilities employ more nonprofessional nursing staff in markets in which professional nurse wages are higher. RN staffing levels are higher in markets with a higher percentage of self-pay nursing home residents and a lower percentage of for-profit nursing homes. Controlling for resident characteristics, the use of labor-saving practices is higher in markets with higher average nursing home wages, suggesting that there are economic incentives to hire fewer nursing personnel.
Assuntos
Casas de Saúde/economia , Recursos Humanos de Enfermagem/economia , Salários e Benefícios/estatística & dados numéricos , Eficiência Organizacional , Recursos Humanos de Enfermagem/provisão & distribuição , Estados Unidos , Recursos HumanosRESUMO
This research study utilizes indicators from federal and state surveys to evaluate variation in outcomes in 438 Medicare certified skilled nursing care facilities in Pennsylvania. First, a standardization function adjusting for patient characteristics known to influence outcomes was developed and estimated. The relationships between organizational and environmental characteristics and the chosen outcome indicators (i.e., differences between the actual and expected rate of mortality, pressure ulcers, urethral catheterization and physical restraints) were then analyzed by weighted least squares regression. Results suggest considerable interfacility variation in rates for these outcome indicators. A portion of this variation is significantly attributable to resident characteristics (P < or = 0.05). However, variation in outcomes in Pennsylvania facilities is also associated with facility characteristics (e.g., size and for-profit status), and environmental characteristics (e.g., per capita income and bed supply). Implications for nursing home management and policy are considered.