American health care environment in the 1990s
Some hospitals seek affiliations with other health care providers. Participants in such affiliation actions, however, frequently are distrustful of the motives of the other party (Johnsson, 1992, p. 20). Bringing physicians and other professional health care providers into a hospital organization represents a form of hospital diversification. The focus in such diversification actions is on the building of communication, networks and partnerships. From a systems perspective, the hospital aligns its internal systems with the delivery system outside of the hospital in order to better manage the health care of the community.

Other hospitals respond in different ways. Among these alternative approaches are initiatives by hospitals to advertise their services to the end user. Advertising to the end user by hospitals is intended to partially circumvent the institution's dependency upon physician referrals by causing potential patients to ask for a specific hospital. This study will examine the effects of the use of advertising by one hospital.

Changes in the health care system, financial responsibility shifts, technical medical advances, and medical care rationing are among the factors that are driving health care providers of all stripes toward affiliations that in turn become health care systems (Tong, 1995, p. 165). When hospitals engage in such transformations, one of the managerial innovations introduced is the use of advertising.

 
 
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