Hospital Selection into Multihospital Systems: The Effects of Market, Management, and Mission uri icon


  • The growing literature on multihospital systems (MHS) has concentrated on assessing system performance without a concurrent examination of the as- sumptions related to the conditions under which hospitals and systems affiliate with each other. Using a net present-value framework the current study de- velops and tests a model that explains the entry patterns of hospitals into multihospital systems. Specifically, we assess the role of the hospital's market, management activity, and mission compatibility with the system as predispos- ing conditions of MHS affiliation. The model is tested on a sample of 306 affiliated and 918 nonaffiliated hospitals under conditions of market equilib- rium and disequilibrium, and for hospital entry into both non-profit and in- vestor-owned multihospital systems. Results suggest that the relative impact of market factors, hospital management characteristics, and mission compatibility on MHS entry will vary systematically as a function of assumptions about the hospital's market and the type of system with which the hospital affiliates. Key words: MHS; selection into investor-owned MHS; nonprofit MHS; hospitals, affiliation with MHS. (Med Care 1988; 26:159-176).

author list (cited authors)

  • Alexander, J. A., & Morrisey, M. A.

citation count

  • 32

complete list of authors

  • Alexander, JA||Morrisey, MA