title: Ambulatory surgery center and general hospital competition: entry decisions and strategic choices.
abstract: BACKGROUND
  General hospitals are consistently under pressure to control cost and improve quality. In addition to mounting payers' demands, hospitals operate under evolving market conditions that might threaten their survival. While hospitals traditionally were concerned mainly with competition from other hospitals, today's reimbursement schemes and entrepreneurial activities encouraged the proliferation of outpatient facilities such as ambulatory surgery centers (ASCs) that can jeopardize hospitals' survival.
  
  
  OBJECTIVE
  The purpose of this article was to examine the relationship between ASCs and general hospitals. More specifically, we apply the niche overlap theory to study the impact that competition between ASCs and general hospitals has on the survival chances of both of these organizational populations.
  
  
  METHODS
  Our analysis examined interpopulation competition in models of organizational mortality and market demand. We utilized Cox proportional hazard models to evaluate the impact of competition from each on ASC and hospital exit while controlling for market factors. We relied on two data sets collected and developed by Florida's Agency for Health Care Administration: outpatient facility licensure data and inpatient and outpatient surgical procedure data.
  
  
  RESULTS
  Although ASCs do tend to exit markets in which there are high levels of ASC competition, we found no evidence to suggest that ASC exit rates are affected by hospital density. On the other hand, hospitals not only tend to exit markets with high levels of hospital competition but also experience high exit rates in markets with high ASC density.
  
  
  CONCLUSIONS
  The implications from our study differ for ASCs and hospitals. When making decisions about market entry, ASCs should choose their markets according to the following: demand for outpatient surgery, number of physicians who would practice in the surgery center, and the number of surgery centers that already exist in the market. Hospitals, on the other hand, should account for competition from ASCs while making market-entry decisions and while developing their strategic plans.
authors: Department of Healthcare Administration, Sawyer School of Business, Suffolk University, Boston, MA, USA. malamin@suffolk.edu
authors: Mona
authors: M
authors: Al-Amin
authors: Michael
authors: M
authors: Housman
mesh_terms: D003659:Decision Making, Organizational; D004465:Economic Competition; D017598:Efficiency, Organizational; D005161:Facility Regulation and Control; D005431:Florida; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006302:Health Services Research; D018578:Hospital-Physician Relations; D006769:Hospitals, General / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007373:Interinstitutional Relations; D038801:International Classification of Diseases; D010934:Planning Techniques; D013531:Surgicenters / Q000191:economics* / Q000706:statistics & numerical data