Doctor of Philosophy
Health Services Organization and Research
Thomas T. H. Wan
This study examined hospital characteristics that affected the differential in hospital mortality, while controlling for the effect of community attributes. Analytical models for the determinants of hospital mortality were formulated and validated through an empirical examination of 243 hospitals that had higher or lower mortality rates than expected for Medicare beneficiaries. The dependent variable for this study was death rates for 1984 Medicare patients in united states hospitals released in 1986 by the Health Care Financing Administration.
Structural equation models that portray the causal relation between organizational constructs and hospital mortality rate were formulated. This causal model was empirically validated. The findings suggest that the "size" effect on hospital mortality is a spurious one. Specialization was found to be negatively related to hospital mortality when the effects of other variables were simultaneously controlled. Hospitals having a higher degree of specialization tended to have a lower mortality rate. The effect of service intensity on hospital mortality was statistically significant when control variables were added into the equation. Thus, a hypothesized positive relationship between service intensity and hospital mortality was confirmed; the greater the service intensity, the higher the mortality.
Ownership and crude death rate both had a negligible effect on hospital mortality. The only control variable that was statistically significant is "teaching status". The teaching hospitals had a lower mortality rate than nonteaching hospitals did when other organizational factors were controlled.
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