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BENCHMARKING COMMUNITY HEALTH CENTERS' EFFICIENCY:MULTIVARIATE ANALYSIS
Title
BENCHMARKING COMMUNITY HEALTH CENTERS' EFFICIENCY:MULTIVARIATE ANALYSIS.
Creator
Marathe, Shriram, Wan, Thomas, University of Central Florida
Abstract / Description
Community Health Centers (CHCs), designed to provide accessible and affordable health care services to low-income families, were first funded by the Federal Government as part of the War on Poverty in the mid-1960s. Improving healthcare organizational performance efficiency is paramount. It is an especially pressing need for CHCs' because they carry a disproportionate burden of caring for the uninsured within limited budgets. Prior studies suffer from conceptual and methodological...
Show moreCommunity Health Centers (CHCs), designed to provide accessible and affordable health care services to low-income families, were first funded by the Federal Government as part of the War on Poverty in the mid-1960s. Improving healthcare organizational performance efficiency is paramount. It is an especially pressing need for CHCs' because they carry a disproportionate burden of caring for the uninsured within limited budgets. Prior studies suffer from conceptual and methodological limitations. A longitudinal multivariate analysis of factors influencing the performance of CHCs is needed. The purpose of this study is to benchmark CHC performance in terms of technical and cost efficiency, and examine factors that affect its variation. A theoretically grounded non-experimental study design is used, with five waves of panel data from 493 CHCs for the years 2000 through 2004. This study found that data mining and predictor tree analysis of factors influencing the variation in CHCs' technical and cost efficiency yielded inconsistent results. A declining trend in technical efficiency scores over the five-year study period was observed. Based on growth curve modeling, the three factors that influenced technical efficiency at the initial period of the study are: the percentages of Medicare, Medicaid, and Hispanic population being served by the CHCs. The five factors that positively influenced the variation in cost efficiency at the initial period were: the initial score of technical efficiency, the percentage of Hispanic patient population, staffing mix (ratio of providers to total staff), pay mix (ratio of federal grant dollars to total revenue), and percentage of Medicare-eligible. The initial cost-efficiency score and the initial technical efficiency score are negatively associated with the growth trend of technical efficiency. The initial level of technical efficiency is not statistically significantly associated with the growth trend of cost efficiency. The two factors influencing the growth trend of cost efficiency are the growth trend of technical efficiency (with a positive influence) and the initial level of cost efficiency (with a negative influence). Analysis of the effects of contextual and organizational-structural variables on the technical efficiency and cost efficiency of community health centers found that the explanatory power of the predictors is much greater for cost efficiency than for technical efficiency. The study lends support to contingency theory and confirms the independent and additive influences of contextual and organizational predictors on efficiency. Irrespective of the efficiency measures, contextual factors have much more influence on CHCs' efficiency than design (organizational structural) factors do. The three study hypotheses supported by multivariate analysis are: technical efficiency is associated with contextual factors and organizational factors; cost efficiency is associated with contextual factors and organizational factors; and technical efficiency positively affects cost efficiency.
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Date Issued
2006
Identifier
CFE0001408, ucf:47067
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0001408
REDUCING NON-URGENT UTILIZATION OF THE EMERGENCY DEPARTMENT BY SELF-PAY PATIENTS: ANALYSIS OF THE IMPACT OF A COMMUNITY-WIDE PROVIDER NETWORK
Title
REDUCING NON-URGENT UTILIZATION OF THE EMERGENCY DEPARTMENT BY SELF-PAY PATIENTS: ANALYSIS OF THE IMPACT OF A COMMUNITY-WIDE PROVIDER NETWORK.
Creator
van Caulil, Karen, Liberman, Aaron, University of Central Florida
Abstract / Description
The purpose of this study was to determine whether a coordinated and comprehensive system of care for the uninsured changed the behavior of the uninsured by decreasing non-urgent utilization of the emergency departments within a large, urban county. The literature on emergency department trends and interventions designed to decrease "inappropriate" or non-urgent use of the emergency departments was reviewed and links to relevant theoretical concepts were identified. Utilization data from six...
Show moreThe purpose of this study was to determine whether a coordinated and comprehensive system of care for the uninsured changed the behavior of the uninsured by decreasing non-urgent utilization of the emergency departments within a large, urban county. The literature on emergency department trends and interventions designed to decrease "inappropriate" or non-urgent use of the emergency departments was reviewed and links to relevant theoretical concepts were identified. Utilization data from six emergency departments and six federally qualified health centers were evaluated. Secondary data over a three-year time period were abstracted from patient and organizational records at the hospitals and federally qualified health centers. The utilization data from the emergency departments and health centers were compared. The analysis revealed a significant change in the number of non-urgent visits by self-pay patients at the emergency departments when the health centers expanded. A 32.2 percent decrease in utilization of the emergency departments by self-pay patients was found. Non-parametric tests demonstrated significant differences in the population seen at the emergency departments and the clinics over the three-year study period. Regression analysis demonstrated a statistically significant decrease in non-urgent, self-pay visits at the emergency departments as a result of the increase in self-pay visits at the federally qualified health centers. Further analysis includes forecasting the impact of future federally qualified health centers on emergency department utilization. Recommendations for future research include evaluation of the increased numbers of non-urgent transports from the local emergency medical system by self-pay patients as well as the design of a pilot study to look at the effectiveness of transporting these patients to the federally qualified health centers for care instead of to the local emergency departments.
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Date Issued
2005
Identifier
CFE0000436, ucf:46393
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0000436