Date of Award

Spring 2020

Document Type

Open Access Dissertation


Moore School of Business

First Advisor

Mark Ferguson

Second Advisor

Luv Sharma


Hospitals and physicians are often required to adapt their operations in response to macro changes in their industry environment. This dissertation examines the operational factors which influence and incentivize changes in hospital and physician operating performance. The first essay in this dissertation investigates how legislative political support and competition in the area in which a hospital operates influences hospitals’ investments and commitment to complying with performance mandates implemented by the Patient Protection and Affordable Care Act (ACA) legislation in the United States. Leveraging United States hospital performance data from 2007 to 2014, results indicate a differential impact of government ideology on recently introduced patient experience metrics versus traditional clinical metrics. These findings contribute to the research regarding the impact of firms’ operating environments on the effectiveness of industry policy adoption, particularly in situations where future uncertainty of existing legislative mandates is high.

The second essay in this dissertation focuses on the unintended impacts to physician opioid prescribing behavior created by the passage of the ACA. This study aims to enhance our understanding of the factors associated with opioid prescription behavior and provide prescriptive insights to reduce opioid prescribing, which serves as the principal gateway to opioid addiction. Specifically, this study examines how v prescriber workload, introduction of the Value Based Purchasing (VBP) program, and market competition influence opioid prescribing. Results demonstrate an increase in opioid prescription rates following the introduction of the VBP program, along with a moderating impact of prescriber workload and market competition on opioid prescription rates. These findings inform the discussion on the health and societal impacts of the opioid epidemic in the United States, while providing prescriptive implications to hospital managers, prescribers and policymakers about the influence of operational and competitive factors on opioid prescription rates. Together, these studies provide empirical support for the influence of operational factors on hospital and physician responses to environmental changes in the US healthcare industry.


© 2020, Justin Taylor Kistler