What Really Matters? Organizational Versus Regional Determinants of Hospitals Providing Medical Service Centres

Health Policy. 2020 Dec;124(12):1354-1362. doi: 10.1016/j.healthpol.2020.07.011. Epub 2020 Aug 23.


By adding medical service centres (MSCs) to their range of services, hospitals can participate in the outpatient sector. The aim of the MSC guideline (2004) was to ensure high quality health care in rural areas. It is unknown if organizational or regional factors influence hospitals providing services via MSCs. Our analyses focus on the identification of factors that explain the operation of an MSC by hospitals. The data are based on the mandatory structured quality reports of German hospitals (n = 1,605). These organizational data (teaching status, size and ownership) are supplemented by settlement structure and contextual data (e.g., location, doctor density). We estimated a cross-sectional multilevel logistic regression model to identify determinants of hospitals operating MSCs. In 2017, 27% of 1,605 hospitals had one or more MSCs. On an organizational level, for-profit ownership (-) and the number of beds (+) were significant determinants of providing MSCs. The analyses show that the interaction between settlement structure and ownership has an influence on the operation of an MSC. Organizational factors determine the provision of MSCs, with regional determinants playing a role as well. This indicates that hospital behaviour is difficult to predict and that individual factors shape both profit orientation and responsibility for sufficient health care in the region.

Keywords: Germany; ambulatory care; hospitals.

MeSH terms

  • Cross-Sectional Studies
  • Hospitals, Private*
  • Humans
  • Logistic Models
  • Ownership*
  • Quality of Health Care