The health care field is moving rapidly toward integrated delivery systems (IDS). The role of home care in such system is unclear. This study seeks to describe the current status of home care in IDS and to examine health care administrators' perceptions about the importance of IDS components. A random sample of 1600 administrators was surveyed, 400 each from home care agencies, hospitals, nursing homes, and medical groups. Results reveal that hospitals lead integration, nursing homes are least involved, and home care agencies and medical groups fall in between. Administrator's opinions vary considerably about the importance of select services and integrating mechanisms.

This study indicates that the nationwide CEO turnover rate is lower than many people estimate but was still, in 1987, an uncomfortable 22 percent on average. Some of this turnover may help some hospitals, for example, those with incompetent administrators. Some turnover may be natural in that some CEOs may have retired or died. Other turnover is controlled, such as that in the investor-owned sector where planned movement is expected. The analysis of the data in this study indicates that smaller hospitals experience higher turnover rates than do their larger counterparts. In 1987 Sun Belt and western hospitals experienced greater turnover than upper midwestern and eastern hospitals. As a group, however, the investor-owned sector led in turnover rates among hospital CEO turnover rates.

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As healthcare reform is debated over the next several years, not-for-profit hospitals will see increased challenges to their tax-exempt status. Over the past forty years, the requirements for maintaining a tax-exempt status have undergone numerous changes. In the last several years, several states have challenged the right of hospitals to maintain this desired status. As we move toward the mid-1990s, it will be critical for not-for-profit hospitals to demonstrate and communicate their commitment to charitable endeavors.