VCU professor is grantee spotlight for health policy organization

By Malorie Burkett

Gloria J. Bazzoli, Ph.D., professor in health administration at Virginia Commonwealth University, is featured as the grantee spotlight for the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization program (HCFO).

Over the course of three HCFO grants, Bazzoli has explored a variety of health care structures, including local trauma systems, physician-organization arrangements and the hospital safety net — hospitals or health systems that provide a significant level of care to low-income, uninsured and vulnerable populations.

In her first HCFO study, examining the structure and organization of regionalized trauma care systems, Bazzoli and her colleagues found that a common deficiency among state and regional organizations in establishing trauma systems was a failure to limit the number of designated trauma centers based on community need.

They also determined that several systems lacked standardized policies for inter-hospital transfer and systemwide evaluation.

“Regionalized trauma systems have proven themselves effective in rapidly responding to the needs of severely injured patients and saving lives,” said Bazzoli. “Emulating the structures and processes of successful models of trauma regionalization is critical for effective patient care.”

In a second project, Bazzoli and colleagues explored the convergence of hospital, health market, regulatory and community characteristics that influence the development of physician-organization arrangements. The results showed that global capitation — a method for paying health providers for services that they either deliver themselves or that they arrange for a group of health plan enrollees — motivated tighter integration between physicians and hospitals. However, the researchers did not find a reduction in hospital costs as they had anticipated.

“What we learned is that financial incentives do change the ways that physicians and
hospitals link together, but this did not lower the costs of health care delivery during the period studied,” said Bazzoli. “The latter was critical for payment methods like global capitation to succeed.”

Most recently, Bazzoli has examined how the U.S. hospital safety net has been affected by factors including the Balanced Budget Act of 1997, an increase in the number of uninsured patients and the growth in both private managed care and Medicaid managed care.

Bazzoli and her colleagues found that during the Balanced Budget Act period, the hospitals that were core to safety-net delivery reduced uncompensated care in response to Medicaid financial pressure. However, voluntary safety-net hospitals — which provide less indigent care than core institutions — only responded this way when faced with the combined forces of Medicaid and private-sector payment pressures.

In addition, Bazzoli and her colleagues explored how hospitals have changed the public health and specialty-service provisions that uninsured individuals typically use.

They found that non-safety net hospitals trimmed certain services commonly used by the indigent, and this may point to future reductions in access.

“Overall, our findings do not bode well for the future of the safety net, which continues to be financially strained and is dealing with growing numbers of uninsured patients,” said Bazzoli. “Many strains will affect hospitals, physicians and other health organizations in the years to come, and it’s important for policymakers to understand how providers respond to these pressures, especially the ultimate effects on patients and payers.”

Bazzoli’s research covers various subjects in the areas of health economics and the organization of health care delivery, including the restructuring of hospital markets, changing relationships between physicians and hospitals and changing financial incentives.

She received her bachelor’s degree from the University of Illinois and her master’s and doctoral degrees in economics from Cornell University.