Does Money Really Matter? The Effects of Organizational Finances on Quality of Health Care
Open Access
- Author:
- Beauvais, Brad Michael
- Graduate Program:
- Health Policy and Administration
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- February 16, 2007
- Committee Members:
- Dr Rebecca Wells, Committee Chair/Co-Chair
Dr Jami Delli Fraine, Committee Chair/Co-Chair
Susan Diane Brannon, Committee Member
Dr Joeseph Vasey, Committee Member
Dr Frank Lawrence, Committee Member - Keywords:
- Quality
Health Care
Finance - Abstract:
- This dissertation is divided into three separate but related studies pertaining to organizational finances and quality of health care. The first study identifies the pertinent empirical literature on the topic of interest and provides a unifying conceptual framework with reference to each study’s focus and quality measures. The second study investigates the finance-quality relationship within Department of Defense hospitals. The third and final study follows a similar investigative approach with federally funded community health centers serving as the unit of analysis. The purpose of the first study was to uncover the existing empirical literature as it pertains to the relationships between healthcare organizational finances and quality of care. Based on these findings I was able to develop the bases for predictions about how health care organization finances would affect quality within other organizational contexts. Eventually only 16 empirically rigorous studies on this topic were drawn from the available literature between 1980 and 2005. Collectively, these articles indicate that organizational expenses, net margins, and asset and liability management all affect healthcare outcome quality. There is less evidence about how organizational finance factors affect structural or process quality. The purpose of the second study was to empirically test the association between financial resources and health care quality in Department of Defense hospitals. Financial and organizational data from the 2003 Health Care Survey of Defense Department Beneficiaries (HCSDB) and 1999-2003 data from the Department of Defense Medical Expense Performance Reporting System (MEPRS) are used. I employ a measure of military treatment facility fiscal margin to predict seven Consumer Assessment of Health Plan Satisfaction (CAHPS) quality dimensions. Ordinary least squares regression analysis and multilevel modeling are the primary statistical methods. Results indicate a significant and positive association between organizational finances and quality outcomes. This indicates that organizations with more financial flexibility may be more adept at meeting or exceeding patient care expectations. The purpose of the third study was to determine the nature of the finance-quality association within the ambulatory care context. The number of federally funded health centers has increased significantly due to a major Bush administration expansion initiative. As the number of health centers has increased, however, questions remain about financial capacity to provide quality care. In this study, I hypothesize that health centers with greater fiscal margins will provide preventive and primary care to a greater proportion of their patients. Seven years (1998-2004) of data are used from the Health Resources and Services Administration’s Uniform Data System, to test the association between organization finances and four process quality dependent variables, inclusive of two preventive care measures (e.g., percent of patients receiving PAP smears and percent under routine health supervision) and two well child/mother measures (e.g., % receiving first trimester care and % receiving post partum care). Multilevel modeling is the primary statistical method. Results indicate a significant and positive cross sectional association between organizational financial margins and percentages of patients receiving preventive health care. Findings are less supportive or negatively oriented when primary care is the dependent variable of interest. Based on our findings, health center net revenue may be responsible for initial preventative care improvements, but appears less supportive of primary care service enhancement. Surprisingly, however, I also find the preventative care advantages gained from higher comparative net revenues to diminish while primary care (i.e., post partum care) services are enhanced over time. In sum, this series of investigations addresses a significant gap in the health services literature pertaining to organizational financing and health care quality for three reasons. First, this research is the first known application of multi-level modeling in research applied to the finance-quality relationship, providing perspective on how organizational finances influence health care quality over time. Second, Department of Defense hospitals and federally funded community health centers are under studied organizations that comprise essential portions of the nation’s health care safety net. Third, with the recognized shortcomings in health care quality on a national scale and U.S. health care costs exceeding $1.7 trillion each year – and growing – there has never been a more appropriate time to investigate the finance-quality relationship (CMS, 2006; AHA, 2006).