Date of Award


Degree Name

Doctor of Philosophy


Public Affairs and Administration

First Advisor

Dr. Kathleen M. Reding

Second Advisor

Peter Kobrak

Third Advisor

Robert Nicholson


This is a multiple case study that examined three hospital patient accounting departments since the adoption of the prospective payment system (PPS). The cases were chosen based on similarities such as their size and dependence on government programs for reimbursement, interviews were conducted and documents were reviewed from 1985 and 1990. Measures of gross revenue days in accounts receivable and the ratio of the number of full time equivalents (FTEs) to patient encounters were used to determine whether these patient accounting departments were more efficient in 1990 than in 1985.

Despite their selection of different forms of adaptation, all three hospitals became more efficient. The three hospitals chose markedly different strategies to cope in the PPS environment. One hospital focused on efficiency changes, the second zeroed in on customer relations, and the third opted for an organizational-development approach.

Access Setting

Dissertation-Open Access