Gloria J. Bazzoli, Ph.D.

September 15, 2005

Over the course of three HCFO grants, Gloria J. Bazzoli, Ph.D., Professor of Health Administration at the Virginia Commonwealth University, has explored a variety of health care structures, including local trauma systems, physician-organization arrangements and the hospital safety net.

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 interhospital transfer and systemwide evaluation. Bazzoli notes that “regionalized trauma systems have proven themselves effective in rapidly responding to the needs of severely injured patients and saving lives. 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 confluence of hospital, health market, regulatory and community characteristics which influence the development of physician-organization arrangements. The results showed that global capitation did motivate 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. The latter was critical for payment methods like global capitation to succeed,” says Bazzoli.

Most recently, Bazzoli has examined the effects of the Balanced Budget Act of 1997 and other major trends (i.e., growth in the number of uninsured, growth in private managed care, and Medicaid managed care) on the US hospital safety net. Among their main findings, Bazzoli and her colleagues found that hospitals that are core to safety net delivery in their markets reduced their uncompensated care in response to Medicaid financial pressure during the BBA period. Voluntary safety net hospitals, which provide less indigent care than core institutions, also responded in this way but only when faced with the combined forces of Medicaid and private sector payment pressures. These results are consistent with theories of hospital behavior when institutions face reductions in payment and raise concern given continuing state budget crises plus recent federal deficit reduction legislation that takes aim at Medicaid expenditures. In addition, Bazzoli and her colleagues explored how hospitals have changed their provision of public health and specialty services typically used by uninsured individuals. They found that non-safety net hospitals trimmed certain services commonly used by the indigent, and this may point to future reductions in access. Bazzoli points out that “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.”

Bazzoli’s research portfolio covers a wide variety of 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 says that “many stresses and strains will affect hospitals, physicians, and other health organizations in the years to come and it is important for health policy makers to understand how providers respond to these pressures, especially the ultimate effects on patients and payers.”

Bazzoli received her B.A. from the University of Illinois at Champaign–Urbana, her M.S. and Ph.D. in economics from Cornell University.

Articles from HCFO-funded projects:

Bazzoli, GJ, Kang, R, Hasnain-Wynia, R, and Lindrooth, RC, “An Update on the Safety-Net Hospitals: Coping with the Late 1990s and Early 2000s,” Health Affairs 24 (July/August 2005): 1047-1056.

Bazzoli, GJ, Lindrooth, RC, Hasnain-Wynia, R, and Needleman, J, “The Balanced Budget Act of 1997 and US Hospital Operations,” Inquiry 41 (Winter 2004/2005): 401-417.

Dynan, L; Bazzoli, GJ; and Burns, LR, "Assessing the Extent of Integration Achieved through Physician-Hospital Arrangements," Journal of Health Care Management, 43 (May/June 1998): 242-262.

Bazzoli, GJ; Dynan, L; and Burns, LR, "Capitated Contracting of Integrated Health Provider Organizations," Inquiry 36 (Winter 1999/2000): 426-444.

Bazzoli, GJ; Dynan, L; Burns, LR; and Lindrooth, RC, "Is Provider Capitation Working: Effects of Capitation On Integration and Hospital Costs of Care," Medical Care 43 (March 2000): 311-324.

Bazzoli, GJ; Miller, RH; and Burns, LR, "Capitated Contracting Roles and Relationships in Health Care" Journal of Health Care Management 45 (May/June 2000): 170-186.

Bazzoli, GJ, "Community-Based Trauma System Development: A Summary of Key Facilitating Factors and Barriers," The Journal of Trauma: Injury, Infection, and Critical Care 47 (September 1999): S22-S24.

Bazzoli, GJ; Madura, KJ; Cooper, GF; Maier, RV; and MacKenzie, EJ, "Progress in the Development of Trauma Systems in the United States: Results from a 1993 National Survey" Journal of the American Medical Association 273 (February 1, 1995): 395-401.

Bazzoli, GJ; Harmata; R; and Chan, C, "Community-Based Trauma Systems: An Examination of Structural Development," Social Science and Medicine, 46 (May 1998): 1137-1149.

Bazzoli, GJ; Meersman, PJ; and Chan, C, "Factors that Enhance Continued Trauma Center Participation in Trauma Systems," The Journal of Trauma: Injury, Infection, and Critical Care 41 (November 1996): 876-885.

Bazzoli, GJ; and MacKenzie, EJ; "Trauma Centers in the United States: Identification and Examination of Key Characteristics," The Journal of Trauma: Injury, Infection, and Critical Care 38 (January 1995): 103-110.