Three Essays on Finance and Health Care Organizations.

Health Care Finance;Nursing Home Quality;Counter-Cyclical;Financial Leverage;Corporate Governance;Hospital Technology Adoption;Economics;Finance;Public Health;Social Sciences;Health Sciences;Business;Health Services Organization & Policy

Huang, Sheng-HsiuSmith, Dean G. ;

University of Michigan

关键词: Health Care Finance;    Nursing Home Quality;    Counter-Cyclical;    Financial Leverage;    Corporate Governance;    Hospital Technology Adoption;    Economics;    Finance;    Public Health;    Social Sciences;    Health Sciences;    Business;    Health Services Organization & Policy;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/102320/shenghsi_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

This dissertation includes three essays that examine the interactions between financial arrangements and product market outcomes in the health care industry theoretically and empirically. Integrating finance and health economic theories, particularly the coexistence of mixed ownerships and the private provision of public goods, my dissertation presents unique opportunities to explore the interaction of the fields of health care finance and industrial organization.Chapter 2 includes an evaluation of nursing home quality, which provides a valuable opportunity to clarify the cyclical fluctuation of quality and the role of financial constraints in explaining such fluctuation. As such, I use local unemployment rates to provide exogenous cost shocks. During recessions, lower labor costs ease financial constraints and thus lead to higher nurse staffing, lower employee turnover, and better quality. Such counter-cyclical quality fluctuation is most profound among financially constrained facilities that tend to be more leveraged. This counter-cyclical quality is also more pronounced among nursing homes that are for-profit, belong to multi-facility chains, and focus largely on Medicaid residents. Overall, I find that financial constraints hinder quality, nursing home quality is counter-cyclical, and financial constraints slightly amplify counter-cyclical quality fluctuations.Chapter 3 examines the impacts of financial leverage on hospitals’ technology adoptions. To account for the potential endogeneity between financing and producing decisions, the California Seismic Retrofit Mandate is used as an exogenous financial shock that crowds out hospitals’ financial resources. Surprisingly, I did not find significant results to identify the association between financial leverage and technology adoption. Using a unique 8-year nursing home CEOs’ compensation dataset, I make inferences of the objective functions of for-profit and not-for-profit organizations, particularly the differential weights of financial and altruistic (quality) performance. Surprisingly, I find that compensation is not tied to performance. Rather, managers are compensated for more concrete measures including the size of the nursing home, payer-mix, and manager experience. I further separate managers into three groups (not-for-profit managers, for-profit and owner-managers, and for-profit and non-owner managers). Among these three types of managers, I find consistently significant evidence that owner-managers earn significantly higher compensation than do the other two types of managers.