title: Whom do they serve? Community responsiveness among hospitals affiliated with health systems and networks.
abstract: BACKGROUND
  As the US hospital sector becomes more consolidated, concerns have been raised about whether participation in health systems and health networks may reduce community hospitals' response to community health needs.
  
  
  OBJECTIVE
  The following were examined: (1) whether freestanding hospitals and system- and network-affiliated hospitals differed in their level of community responsiveness; and (2) how systems and networks affect the level of community responsiveness in community hospitals.
  
  
  METHODS
  A cross-sectional design was used. The dependent variables included community orientation, provision of community health services, and Medicaid inpatient load. Independent variables were system/network membership and policy and organizational attributes of the health system/network.
  
  
  RESULTS
  With few exceptions, a significantly greater involvement of system and network hospitals was found in providing community health services and inpatient services to Medicaid patients, relative to freestanding hospitals. Community health mission of the system/network and the involvement of the system/network in community partnerships or coalitions were positively related to community orientation in member hospitals. Hospitals affiliated with health systems and hospitals affiliated with more diversified systems or networks tended to provide more community health services. Community health mission of the health system or network was related to greater Medicaid inpatient load in member hospitals.
  
  
  CONCLUSIONS
  In general, affiliation with health systems and health networks appears to be positively related to community responsiveness in community hospitals. Research future can examine whether such greater community responsiveness is because of the development and improvement of communication channels among elements of health systems and health networks and the ability of health systems and health networks to build a platform of general, administrative services to link various constituencies.
authors.affiliation: Department of Health Policy and Administration, School of Public Health, The University of North Carolina, Chapel Hill, North Carolina 27599-7411, USA. SYLEE@email.unc.edu
authors.forename: Shoou-Yih D
authors.initials: SY
authors.lastname: Lee
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Alexander
authors.forename: Gloria J
authors.initials: GJ
authors.lastname: Bazzoli
mesh_terms: D003153:Community Health Services; D019058:Community Networks; D005544:Forecasting; D006279:Health Maintenance Organizations; D006302:Health Services Research; D006761:Hospitals / Q000706:statistics & numerical data / Q000639:trends*; D006764:Hospitals, Community; D006801:Humans; D016014:Linear Models; D008484:Medicaid; D008962:Models, Theoretical; D015999:Multivariate Analysis; D011243:Preferred Provider Organizations; D014481:United States