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| Publications [#238878] of Frank A. Sloan
Journal Articles
- Sloan, FA; Becker, ER, Internal organization of hospitals and hospital costs.,
Inquiry : a journal of medical care organization, provision and financing, vol. 18 no. 3
(Fall, 1981),
pp. 224-239
(last updated on 2024/04/18)
Abstract:
This study contributes to current knowledge about hospital boards and executive committees in these ways. First, on balance, from the standpoint of hospital expense per adjusted patient day and/or admission, there is no reason to exclude physicians from boards, and there is even some indication that costs are lowered when doctors participate. The precise mechanism is unclear. Even though physician presence on boards can provide a forum for arguing self-interest of doctors, their presence probably also increases physician awareness of effects of micro decisions on the overall picture. This inference should be tempered somewhat, since the regressions also show that costs are lower in hospitals with executive committees without physician members. Second, variables such as board size have no effect on the overall costliness of the hospital. Large boards often exist to please or appease certain constituencies in the community rather than to participate actively in hospital decisionmaking. Papers often end with pleas for future research. In this instance, however, the case for additional research is unusually strong. First, empirical analysis with more comprehensive cost-dependent variables is at the top of the list. Second, hospitalwide efficiency measures may obscure important developments at the level of individual departments; analysis should be conducted at this level. Third, hospital regulation often has been viewed as a mechanism for achieving positive internal organizational changes within hospitals. There is no hard evidence to date that regulation has had such effects, but certainly this is a legitimate empirical question. Fourth, research on the effects of introducing specific cost-minimizing incentives with regard to doctors' behavior in hospitals should have a high priority.
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