title: Managed care, vertical integration strategies and hospital performance.
abstract: OBJECTIVE
  The purpose of this study is to examine the association of managed care with hospital vertical integration strategies, as well as to observe the relationships of different types of vertical integration with hospital efficiency and financial performance.
  
  
  METHODS
  The sample consists of 363 California short-term acute care hospitals in 1994. Linear structure equation modeling is used to test six hypotheses derived from the strategic adaptation model. Several organizational and market factors are controlled statistically.
  
  
  RESULTS
  Results suggest that managed care is a driving force for hospital vertical integration. In terms of performance, hospitals that are integrated with physician groups and provide outpatient services (backward integration) have better operating margins, returns on assets, and net cash flows (p < 0.01). These hospitals are not, however, likely to show greater productivity. Forward integration with a long-term-care facility, on the other hand, is positively and significantly related to hospital productivity (p < 0.001). Forward integration is negatively related to financial performance (p < 0.05), however, opposite to the direction hypothesized.
  
  
  CONCLUSIONS
  Health executives should be responsive to the growth of managed care in their local market and should probably consider providing more backward integrated services rather than forward integrated services in order to improve the hospital's financial performance in today's competitive health care market.
authors.affiliation: National Defence Medical Center, Taipei, Taiwan.
authors.forename: B B
authors.initials: BB
authors.lastname: Wang
authors.forename: T T
authors.initials: TT
authors.lastname: Wan
authors.forename: J
authors.initials: J
authors.lastname: Clement
authors.forename: J
authors.initials: J
authors.lastname: Begun
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D017598:Efficiency, Organizational; D005377:Financial Management, Hospital; D006302:Health Services Research; D006739:Hospital Administration / Q000706:statistics & numerical data*; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration*; D014481:United States