HOSPITAL SERVICES AND COMMUNITY CHARACTERISTICS - PHYSICIAN AS MEDIATOR

In an analysis of short-term medical and surgical hospitals in a nationwide sample of communities, we found a clear relation between physician characteristics and both variety and duplication of hospital-based health care services. Diversity of physician specialties was directly related to variety of hospital services in a community and altered the relation between hospital services and population characteristics such as education and age diversity. The ratio of physicians to the population was a strong predictor of the duplication of hospital-based services. While both financial and patient care personnel resources were also directly related to differentiation of services, per capita community income was not. Results emphasize the important role played by boundary-spanning agents, such as physicians, who channel resources and demands to organizations. Findings also indicate that health care policy designed to encourage an equitable distribution of facilities and providers should focus on the relation between hospital and physician.