Market forces and organizational evolution at freestanding children's hospitals in the United States

Objectives.-To describe market forces that affect freestanding children's h ospitals, to describe the development of formal business relationships amon g these hospitals and pediatricians and other health care delivery organiza tions, and to explore the impact of such changes on the roles and missions of these hospitals. Methods.-All freestanding children's hospitals in the United States in 1991 were identified (n = 44). A survey was mailed to the chief executive offic er of each hospital. Data were collected for the period of 1991 through 199 6. Twenty-nine of the 44 hospitals surveyed responded. Results.-Twenty-seven (93.1%) of the 29 hospitals reported an increase in c ompetition and a more advanced stage of market evolution. Twenty-five hospi tals (86.2%) developed at least one type of business relationship with pedi atricians or another health care organization. Twenty-one (72.4%) developed a network of pediatricians. Seventeen (58.6%) developed a relationship wit h an adult-focused health care organization. There were no significant diff erences in teaching, research, or charity care activities between those res pondents that developed a pediatric network and those that did not or betwe en those respondents that integrated with adult-focused health care organiz ation and those that did not. Conclusions.-Nearly all freestanding children's hospitals developed new bus iness relationships with physicians and other health care organizations. Th ese new relationships were not associated with any significant changes in t eaching, research, or charity care.