All ETDs from UAB

Advisory Committee Chair

Stephen J O'Connor

Advisory Committee Members

Douglas J Ayers

Jeffrey H Burkhardt

Thomas L Powers

Michael T Weaver

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


Since the 1990s, integrated health care delivery systems have proliferated rapidly in the U.S., but little research has been devoted to studying why hospitals decide to join such systems (e.g., health care networks or systems). The aim of this study was to identify environmental and organizational factors that encourage freestanding hospitals to affiliate with health care networks. Specifically, the relationships of hospital affiliation choice to environmental munificence, environmental uncertainty and organizational resources were examined. Additionally, the moderating effects of hospital setting on these relationships were also investigated. A nonexperimental, longitudinal design was used, with the individual hospital as the unit of analysis. Data for this study were merged from three principle sources: (1) the 1993-1997 American Hospital Association (AHA) Annual Survey of Hospitals; (2) the 1993-1997 Area Resource File (ARF); and (3) the 1993-1997 Online Survey, Certification, and Reporting System (OSCAR). The sample population included 1,129 nongovernment, general acute care, community hospitals that were freestanding hospitals in 1993 and traced from 1993 to 1997. According to study findings, the proposed model was acceptable, which explained 17.1% of hospital affiliation choice and had 52.2% correct predictions. The number of hospital beds, occupancy rate, community orientation, nursing competition, and health maintenance organization (HMO) penetration rate were demonstrated to be significant iii predictors that can successfully separate network-affiliated hospitals from freestanding hospitals. Additionally, hospital setting had moderating effects on the prediction of health care network affiliation through variables of hospital competition and occupancy rate. Unfortunately, few significant factors separated network-affiliated from system-affiliated hospitals in this study. Generally, hospitals located in counties with moderate levels of environmental munificence were more likely to affiliate with health care networks. Additionally, hospitals with more organizational resources were more likely to join health care networks or systems. Finally, future research could focus on improving the generalizability, applicability, and predictability of the model (e.g., enhancing the sample representativeness, applying the model to other industries and/or countries, and including more valid indicators and data), and on expanding the depth (e.g., exploring the degree and amount of relations) and width (e.g., the impact of structural changes on organizational performance) of the model.



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