Munificent environments, management control, and the cost of rural hospital care.

Rural hospitals have been threatened by declining revenues. Control over costs will be necessary to help these hospitals survive. Investigation of the determinants of hospital costs in Iowa reveals that costs are primarily caused by environmental factors, rather than variables over which managers have control. Furthermore, efforts by policy makers to improve hospital efficiency by stimulating competition among hospitals may have been ineffective, since the level of competition was not found to be associated with hospital production costs.

Impact of MR imaging on clinical diagnosis and management: a prospective study.

The clinical value of magnetic resonance (MR) imaging was prospectively evaluated in 189 patients referred for examination of the brain or spine. Comparison of the attending physician's diagnosis, proposed treatment, and estimated prognosis before and after MR imaging indicated a substantial effect of the additional information provided by this study. A suspected diagnosis was refined or changed in 16% of all patients, and the physician's level of confidence in the diagnosis changed in over half of the cases in which the diagnosis was unchanged. In two-thirds of all cases the physician indicated that the treatment or estimated prognosis was altered.

Visits to the physician: an evaluation of the usual-source effect.

Having a regular or usual source for medical care has frequently been found to be an important correlate of ambulatory visits to the physician. However, it remains unclear whether having a usual source is a determinant of visits, a consequence of visits, or both. This article addresses the question, how do these alternative theoretical relationships affect estimates of the relative impact of having a usual source on illness-related visits? The empirical results of a household interview survey generally support the significance of a usual-source variable as a determinant of illness-related visits, but they indicate that use of a single equation-estimation technique may overestimate the magnitude of this effect.

Independent versus system-affiliated hospitals: a comparative analysis of financial performance, cost, and productivity.

This article analyzes differences in the financial performance, cost, and productivity between system-affiliated and independent hospitals. Data for the study were obtained from the 1981 American Hospital Association (AHA) Annual Survey of Hospitals for the State of Iowa and included 94 nonstate or nonfederal short-term hospitals without long-term care units. An interpretation of the results indicated that system-affiliated hospitals are more profitable, have better access to capital markets, are more effective price setters, and experience higher costs per case which are related to longer lengths of stay and less productive use of plant and equipment in generating revenues.

The life and death of a field experiment: a case study of health care research in a hostile environment.

This paper discusses the effects of powerful confounding events on the evaluation of an innovative health care payment program--an experiment with capitation payment for pharmacy services for Medicaid recipients. The research, conducted at the University of Iowa from 1975 to 1982, used a sophisticated experimental design; it was funded by the National Center for Health Services Research, the Health Care Financing Administration, and the State of Iowa, representing an investment of over two million dollars. Despite this investment, and the interest of many at the national level, events in the research environment during this period may well have distorted the conclusions of the research. Thus this case study highlights the problems of conducting evaluation research, particularly social experiments, on innovative programs perceived as threatening to the status quo.