Date of Award


Document Type


Degree Name




First Advisor

Yavuz Yasar


The emergence of specialty service lines in the United States health care system presents many significant questions regarding the access to, provision of, and financing of healthcare. In general terms, specialty service lines represent the newest development in several important trends in the American hospital system and reflect important trends in the wider economy. Many claims have been made regarding the effect of physician-owned specialty hospitals, from their exemption from self-referral prohibitions, their diversion of services away from general hospitals that use high profit margins to subsidize the "safety net," and concerns regarding the over-provision of technologically complex treatments in a system already heavily weighted in favor of specialized medicine. This study will examine the claims made about the differences of physician-owned specialty heart hospitals serving Medicare patients. In doing so, it will employ hierarchical linear modeling, the results of which indicate that specialty service lines may not deliver higher quality care at a lower cost when compared to their general hospital competitors. Rather, there are several significant factors in the hospital market, health insurance market, and demographic features of the population that both groups serve that may have even more notable effects. Because of these complications, this study finally shows the possibility for a dialectical movement resulting from the inadequacies of the argument up to that point, implying further avenues of research on the social character of the commodity of healthcare.


Recieved from ProQuest

Rights holder

Michael Sajovetz

File size

82 p.

File format





Economics, Public health