title: What affects local community hospitals' survival in turbulent times?
abstract: OBJECTIVE
  Hospital closures became a prevalent phenomenon in Taiwan after the implementation of a national health insurance program. A wide range of causes contributes to the viability of hospitals, but little is known about the situation under universal coverage health systems. The purpose of present study is to recognize the factors that may contribute to hospital survival under the universal coverage health system.
  
  
  METHODS
  This is a retrospective case-control study. Local community hospitals that contracted with the Bureau of National Health Insurance in 1998 and remained open during the period 1998-2011 are the designated cases. Controls are local community hospitals that closed during the same period.
  
  
  METHODS
  Using longitudinal representative health claim data, 209 local community hospitals that closed during 1998-2011 were compared with 165 that remained open. Variables related to institutional characteristics, degree of competition, characteristics of patients and financial performance were analyzed by logistic regression models.
  
  
  RESULTS
  Hospitals' survival was positively related to specialty hospital, the number of respiratory care beds, the physician to population ratio, the number of clinics in the same region, a highly competitive market and the occupancy rate of elderly patients in the hospital. Teaching hospitals, investor-owned hospitals, the provision of obstetrics services or home care, and the number of medical centers or other local community hospitals may jeopardize the chance of survival.
  
  
  CONCLUSIONS
  Factors-enhanced local hospitals to survive under the universal coverage health system have been identified. Hospital managers could manipulate these findings and adapt strategies for subsistence.
authors: Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan, R.O.C.
authors: Hung-Che
authors: HC
authors: Chiang
authors: National Environmental Health Research Center, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan, R.O.C.
authors: Shiow-Ing
authors: SI
authors: Wang
mesh_terms: D000367:Age Factors; D016022:Case-Control Studies; D004465:Economic Competition; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D012111:Residence Characteristics; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D019472:Universal Health Insurance / Q000706:statistics & numerical data*
keywords: hospital closure; hospital survival strategies; local community hospitals; universal coverage health system