Author ORCID Identifier

Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Related Sciences

First Advisor

Gloria Bazzoli

Second Advisor

Michael McCue

Third Advisor

Leroy Thacker

Fourth Advisor

Patrick Shay


Academic Health Centers (AHCs) hold a unique place in today’s health care environment. They service their communities through a tripartite mission of education, research, and provision of complex care to disadvantaged populations. To achieve this mission, AHCs face challenges in funding and cost containment compared to non-AHCs. Additionally, the implementation of government programs like the Hospital Readmission Rate Program (HRRP) and Value Based Purchasing (VBP) have the potential to affect AHCs differently from non-AHCs. While AHC’s unique features are known and there has been research to date on HRRP and VBP, literature has yet to statistically explore the financial differences between AHCs and non-AHCs and how HRRP and VBP may have differentially affected AHCs compared to non-AHCs.

The objectives of this study are to explore financial differences between AHCs and non-AHCs and the impact that HRRP and VBP has had on these two types of organizations through the use of a contingency theory framework. Contingency theory is an organizational theory that seeks to explain variations in organizational performance over time by studying internal and external environmental influences.

Guided by Contingency Theory, the study used a non-randomized, quasi-experimental, retrospective study design to evaluate two hypotheses. The study sample consisted of a total of 10,157 (991 AHCs) US non-rural hospital years from 2011 through 2015. The study used operating margin and total margin as the key measures of hospital financial performance for the dependent variables. HRRP and VBP were combined into a single independent variable along with hospital type differentiating AHCs from non-AHCs. Covariates of Herfindahl-Hirschman Index, Medicaid expansion, health system affiliation, and ownership structure were used to control for other environmental influences. A repeated measure analysis of variance was employed to test the difference between the two hospital groups in isolation of HRRP, VBP, and covariates and a repeated measure analysis of variance with covariance was used to test the full model, which incorporated HRRP, VBP, and covariates. The results of the analysis support the significance of HRRP and VBP on hospital operating margin, but the results did not support a differential effect of these programs on AHCs as compared to non-AHCs.

While the results did not support the two main hypotheses, it did provide valuable insight into the financial differences between AHCs and non-AHCs and the importance of VBP and HRRP on hospital financial performance. The results also provide important policy implications and thoughts on potential managerial actions given the HRRP and VBP programs.


© David Allen

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