FACTORS SHAPING RURAL HOSPITAL MANAGED CARE STRATEGIES

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This study provides an analysis of the prevalence of managed care contracting by rural hospitals in two Midwestern states. Since managed care is a relatively new phenomenon in most rural areas and its development in rural areas differs from the development in urban areas, this study provides insights into the current rural health care environment and the ongoing changes affecting a substantial part of the population. The study will identify environmental and organizational factors that predict the engagement of rural hospitals in different types of managed care arrangements. A major focus thereby is the strategic orientation of the hospital as measured by Miles and Snow's strategic types (Miles and Snow, 1978). Data were collected through a survey of rural hospital chief executive officers in Iowa and Nebraska. The survey contains information on characteristics of the hospital service area, managed care activities of the hospital, and the strategic orientation of the hospital. The dependent variable is the likelihood of engaging in a specific managed care strategy. Three different sets of dependent variables are used: contractual arrangements with managed care organizations, current development of managed care organizations by the hospital, and ownership of managed care organizations. Respondents and nonrespondents will be compared using Chi-square tests. Logistic regression is used to analyze the data. Independent models will be run for each of the different dependent variables.