Privatization, system membership, and access to home health care for the elderly

Home health agency (HHA) access based on organizational and market factors is considered, employing a theoretical model of isomorphism for organizational factors and ecological and economic theories for market factors. Data derive from 1986 and 1987 telephone surveys that randomly sampled 185 HHAs from nine metropolitan areas in five states. Results show that competition limits restrictions on access; for-profit status and system membership increase the likelihood that clients will be refused for financial reasons. Findings support the isomorphism theory that fewer access and other behavioral differences appear within systems: nonprofits and for-profits tend to behave alike within systems, whereas freestanding nonprofits are less likely than their for-profit counterparts to refuse access. Findings for system members may account for some of the problems of legitimacy experienced by nonprofit health care organizations.