All ETDs from UAB

Advisory Committee Chair

Janet M Bronstein

Advisory Committee Members

W Jack Duncan

Stephen J O'Conner

Janet M Turan

Document Type


Date of Award


Degree Name by School

Doctor of Public Health (DrPH) School of Public Health


ABSTRACT Between 1975 and 2015, the number of public hospitals decreased by 43%, from 1761 to 1003. Public hospitals have undergone changes in ownership status, structural and/or governance conversions and closures. Reasons for these changes are varied and numerous, however, many studies identify financial difficulties as a major reason that decision-makers consider an ownership change. Some public hospitals persist despite exhibiting financial issues. Therefore, there may be other factors contributing to the persistence of some public hospitals. This paper examines the potential role of social capital or community engagement and cohesion as a factor in determining if a public hospital remains open as a public asset, converts ownership status or structure or closes. Fifteen public hospital; three each in the categories of open, converted-authority, converted-not-for-profit, converted-for-profit and closed, were examined. Sample hospitals were selected based upon conversion status and geographical location; along with urban, suburban or rural dispersion. A financial measure (net income as percentage of total patient revenue) and a county level social capital index were compared individually and jointly to predict public hospital conversion status. The predicted conversion statuses were then compared to the actual conversion status. Financial difficulty alone was shown to impact public hospital conversion status, while social capital alone was shown as not likely to impact public hospital conversion status. Combined social capital and social capital index produced a weak relationship with half of results not predictive of public hospital conversion status.

Included in

Public Health Commons



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