Health Care Policy in the United States
edited by
John G. Bruhn
Pennsylvania State
University-Harrisburg
A GARLAND SERIES
Health Care Policy in the United States
John G. Bruhn, editor
Physician Participation in Medicaid Managed Care
Sunday E. Ubokudom
Healing the Social Body: A Holistic Approach to Public Health Policy
Elizabeth R. Mackenzie
Directing Health Messages toward African Americans: Attitudes toward Health Care and the Mass Media
Judith L. Sylvester
Gender Justice and the Health Care System
Karen L. Baird
Who Cares for Poor People? Physicians, Medicaid, and Marginality
Margaret M. Hynes
Health Care Reform: Policy Innovations at the State Level in the United States
Larry E. Carter
Telemedicine in Hospitals: Issues in Implementation
Sherry Emery
Helping Survivors of Domestic Violence: The Effectiveness of Medical, Mental Health, and Community Services
Judith S. Gordon
Families and Their Health Care after Homelessness: Opportunities for Improving Access
Lisa M. Duchon
Medicaid and the Costs of Federalism, 1984-1992
Jean Donovan Gilman
State Government Provision of HIV/AIDS Prevention Programs: Towards a Partnership Model of the Contractual Relationship Between State
Maria Elena Letona
Remodeling Home Care: Making the Transition from Fee for Service to Managed Care
Meryl Rappaport
Can Efficiency and Community Service Be Symbiotic? A longitudinal Analysis of not-for-profit and for-profit Hospitals in the United States
Sharyn J. Potter
Published in 2000 by
Garland Publishing, Inc.
A member of the Taylor & Francis Group
29 West 35th Street
New York, NY 10001
Copyright 2000 by Sharyn J. Potter
All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without written permission from the publishers.
10 9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Potter, Sharyn J.
Can efficiency and community service be symbiotic?: a longitudinal analysis of not-for-profit- and for-profit hospitals in the United States/Sharyn J. Potter
p. cm (Health care policy in the United States)
Includes bibliographical references and index.
ISBN 0-8153-3633-0
1. Hopital and communityUnited StatesLongitudinal studies. 2. Voluntary hospitalsUnited StatesLongitudinal studies. 3. Hospitals, ProprietaryUnited StatesLongitudinal studies. I. Title. II. Series.
RA965.5 .P67 2000
362.110973
99-055076
Printed on acid-free, 250 year-life paper
Manufactured in the United States of America
For Mike, Audrey and Shelly
This book has benefited from the intellectual and emotional support of many wonderful professors, friends and family. However, I take full responsibility for any remaining deficiencies.
I would like to thank faculty from the Emory University Department of Sociology and the Rollins School of Public Health of Emory University. Karen Hegtvedt and Alex Hicks provided direction, support and suggestions on earlier versions of the manuscript. Tim Dowd continuously challenged me to think about my question in a theoretical framework. As a supportive mentor Dick Levinson attended my ASA presentations at ungodly hours in the morning. I hope that in the future I can emulate his qualities as a caring teacher.
I would especially like to thank my mentor Edmund (Ned) R. Becker for his insight, patience, friendship and sense of humor. I have enjoyed working with Ned for the past six years. During this period I have learned a great deal about research, teaching and politics. I will never forget these lessons, and I will always look back at these times with fondness and appreciation.
I would also like to thank E. Kathleen Adams for being both a mentor and a wonderful friend. The quality and depth of my work evolved through discussions that took place while running and over meals of gummy bears and burritos. I am also grateful to Patrick Mauldin for his encouragement and for his advice to treat graduate school like a full time job in corporate America.
My book has also had the benefit of special friends including Laurel Pickering who introduced me to the Rollins School of Public Health of Emory University and who has encouraged my research endeavors in the health care field. Sunday brunches with Amy Conti Harkness and her son Erik started during our Masters in Public Health program and continued for the next four years brightened many Sundays that were spent in the library. Kris Principe constantly provided me with the benefit of her experience as a doctoral student and was always there to listen and give both advice and friendship. I also thank Margie Pintzow for her support and her many gifts of chocolate during periods of celebration and frustration. Finally, I thank my best friend for the past seventeen years, Liz Krauss for her support. Liz even moved to Atlanta to pursue a Masters in Physical Therapy so we could spend two years in the same city as we pursued our educational goals. I hope I am able to give back to all of you what you have given me in terms of your support and friendship.
I would also like to thank the members of my family who were always a phone call away and moved around family vacations and celebrations to accommodate my work schedule. In particular, I would like to thank my brother Jeremy Potter and my sister Elyse Levy for their love, support and constant encouragement. My parents Audrey and Shelly Potter deserve more thanks than I can ever possibly express. They have constantly told me that I can do anything that I set my mind oh. With these directions they have always been there with love and encouragement and an ear to listen.
Finally, I would like to thank Mike Schwartz for his love, support and patience. Mike has been there since the beginning of this endeavor and has made this journey a special one. Mike has constantly encouraged me to follow my dreams and has been supportive, as these dreams have sometimes led us down unexpected paths. I hope that in the future I can give Mike the same freedom to follow his own dreams.
I realize that these acknowledgements only touch the surface of my deep appreciation and gratitude to all of you for so many different reasons. I know that my career and my personal life has, and will always be enriched from my experiences with all of you. Thank you again.
Sharyn J. Potter
Can Efficiency and Community Service be Symbiotic?
A Longitudinal Analysis of not-for-profit and for-profit hospitals in the United States
In his 1982 Pulitzer Prize-winning book chronicling American medical history, The Social Transformation of American Medicine, Paul Starr cautions that consolidation in the medical industry will make voluntary not-for-profit hospitals indistinguishable from their for-profit counterparts:
