Date of Award

4-13-2026

Embargo Period

5-1-2027

Document Type

Dissertation

Degree Name

Doctor of Health Administration

College

College of Health Professions

First Advisor

Jami Jones

Second Advisor

Dunc Williams

Third Advisor

Caitlin Koob

Abstract

Objective: This study examined descriptive differences in financial performance, financial structure, and operational characteristics across acquired, build-net-new, and remain-independent acute-care hospitals in Florida from 2016 to 2022.

Methods: A retrospective descriptive-comparative design was used with hospital-year observations. Governance strategy was classified using the CMS Provider of Services file, and financial and operational variables were obtained from Medicare Cost Report data accessed through RAND Hospital Data. The analytic sample included 175 hospitals and 1,171 hospital-year observations. Analyses were limited to descriptive statistics; no inferential testing was performed.

Results: Remain-independent hospitals had the highest mean operating and total margins, at 8.99% and 9.41%, respectively. Acquired hospitals had lower mean operating and total margins, at 2.24% and 2.28%, while build-net-new hospitals had negative mean operating and total margins, at -5.89% and -3.49%. Remain-independent hospitals operated at greater financial and operational scale. Case mix index was similar across groups. Yearly patterns fluctuated, with acquired hospitals improving over time and build-net-new hospitals showing mixed annual performance.

Conclusion: Findings show descriptive differences across governance strategies but do not imply causal relationships. Results are consistent with Transaction Cost Economics as a framework for interpreting trade-offs in coordination, capital intensity, and operational scale.

Rights

Copyright is held by the author. All rights reserved.

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