Selling Health: The Role of Religion and Innovation in Healthcare Pubblico

Abstract

This dissertation seeks to explain two central ideas: how innovations spread across hospitals, and how the religious ownership of hospitals continues to impact their behavior. It is divided into three sections. The first section utilizes theories of organizational behavior and the diffusion of innovations to explain the diffusion of bariatric (weight loss) surgery, robotic surgery, and electronic medical records. It leverages heterogeneous diffusion modeling to predict the spread of each innovation. The second section explores how the two surgical innovations are advertised on the web, to evaluate whether hospital organizations employ frames to diversify their adoption of these procedures. Diversity in frames was measured using structural topic modeling and network analysis. The third section looks directly at religion, investigating whether the use of religious language in hospital mission statements predicts their charitable behavior. Indicators of religious and secular language were combined with linear regression to evaluate whether the use of religious language was associated with higher uncompensated care spending. All three sections use the American Hospital Association Annual Reports, linked with the Centers for Medicaid and Medicare Healthcare Cost Reporting Information System Cost Reports. The latter two sections also utilize scraped text from hospital websites, procured using an automated web scraper designed in Python. There were a few key findings. The pattern of innovation diffusion exacerbates healthcare access inequality, and may contribute to the medicalization of obesity. Defying expectations of isomorphism, all three sections find that hospital ownership type continues to predict differences in hospital behavior. Religious ownership was found to be particularly important. When Catholic hospitals adopt an innovation, they tend to cause other hospitals to adopt it. Church-owned hospitals use measurably different language than secular hospitals when advertising procedures. Religious language in a hospital mission statement predicts higher uncompensated care spending, while secular terms associated with charity (mission, giving, donations) do not. 

Table of Contents

1 Introduction 1

2 Unequal Innovation: How the Spread of Healthcare Innovations Can Exacerbate

Inequality 6

2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

2.2 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2.2.1 Seeking Legitimacy or Seeking Profit? The Case of the Healthcare

“Market” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2.2.2 Diffusion as a Mechanism for Isomorphism . . . . . . . . . . . . . . . 11

2.2.3 Why Hospitals Innovate . . . . . . . . . . . . . . . . . . . . . . . . . 12

2.2.4 Using Test Cases to Evaluate Theoretical Expectations . . . . . . . . 21

2.2.5 Unequal Diffusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

2.3 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

2.3.1 Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

2.3.2 Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

2.4 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

2.4.1 Descriptive Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

2.4.2 Heterogenous Diffusion Model Results . . . . . . . . . . . . . . . . . 38

2.5 Conclusion and Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

3 Selling Health: Exploring Lexical Isomorphism in Hospital Websites 49

3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

3.2 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

3.2.1 Framing Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

3.2.2 Framing as Differentiated Diffusion . . . . . . . . . . . . . . . . . . . 51

3.2.3 Framing and Medicalization . . . . . . . . . . . . . . . . . . . . . . . 52

3.2.4 Websites as Frames . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

3.3 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

3.3.1 Data Acquisition and Preparation . . . . . . . . . . . . . . . . . . . . 58

3.3.2 Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

3.4 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

3.4.1 Descriptive Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

3.4.2 Structural Topic Model Results . . . . . . . . . . . . . . . . . . . . . 71

3.4.3 ERGM Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

3.5 Conclusions and Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

3.5.1 Bariatric surgery topics . . . . . . . . . . . . . . . . . . . . . . . . . . 85

3.5.2 Robotic Surgery Topics . . . . . . . . . . . . . . . . . . . . . . . . . . 87

3

4 Christianity and the Corporation 89

4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

4.2 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

4.2.1 A Brief History of Religion in Hospitals . . . . . . . . . . . . . . . . . 90

4.2.2 Rationalization and Secularization . . . . . . . . . . . . . . . . . . . . 94

4.2.3 A Test Case: Website Mission Statements and Charity Care . . . . . 96

4.2.4 Defining Charity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

4.3 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

4.3.1 Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

4.3.2 Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

4.4 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

4.4.1 Descriptive Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

4.4.2 Regression Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

4.5 Conclusion and Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

5 Conclusions from this Dissertation 123

6 Works Cited 125

About this Dissertation

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School	Laney Graduate School
Department	Sociology
Degree	Ph.D.
Submission	Dissertation
Language	English
Research Field	Health Sciences, Health Care Management Religion, General Sociology, Organization Theory
Parola chiave	robotic bariatric diffusion obesity religion EMR neoinstitutionalism innovation catholic healthcare
Committee Chair / Thesis Advisor	Ellen Idler, Emory University Tim Dowd, Emory University
Committee Members	Weihua An, Emory University Giacomo Negro, Emory University Roberto Franzosi, Emory University

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