1

Healthcare Management Education Settings in the United States: History and Perspective

Peter Hilsenrath Eberhardt School of Business

University of the Pacific

History of Healthcare Management Education

Schools of business, public health and health professions are all host to programs in healthcare

management. This is the case in the United States as well as much of the rest of the world. It is

a field that has been evolving and is rich in social complexity. A recent paper in this journal

detailed the marginalization of women in health administration in the early and mid-20th century

as the field became more “professional” (Arndt, 2010). The purpose of this paper is to describe

and explore the lack of locus of academic setting in graduate healthcare management in the

United States. It provides historical narrative and uses institutional economics for theoretical

perspective. The paper serves as a resource for scholars of management history and university

administrators as well as prospective graduate students to help understand differences between

healthcare management programs in schools of business versus health science settings. This is

of growing importance as health expenditure and employment increase in developed and

developing countries.

The history of healthcare management education is relatively short. It is not a form of academic

inquiry with obvious roots in antiquity such as medicine or philosophy even though “hospitals”

have existed since at least the 12th century with the Order of Hospitallers in Jerusalem (Risse,

1999). Some put the origins of hospitals earlier such as ninth century Bagdad, Childebert’s 6th

century establishment of the Hotel-Dieu in Lyon, or as early as 4th century Byzantium

(Chevallier, 2008; Miller, 1978). Rather, graduate level business and public health education are

2

comparative newcomers to academic enterprise. The first graduate program in business was

established at the University of Pennsylvania in 1881 while the first school of public health was

founded at Johns Hopkins University in 1916. Healthcare management education lagged the

arrival of business education more generally. Part of this explanation lies with a hospital

emphasis in the origins of healthcare management education and hospitals did not expand rapidly

until the late 19th and early 20th century. A survey of American hospitals counted only 178

hospitals in 1873 ) while a later survey found 4,359 in 1909 ((Levey, Hilsenrath and Hill, 1998)

Larger hospitals gained market share especially after World War I. The growing complexity of

healthcare services and the shift away from charity care to an increased willingness to pay for

those services, many of them new and based on emerging technologies, catalyzed the need for

qualified hospital and healthcare managers (Thomasson, 2002; O’Leary, 2008).

Medicine was transformed in the late 19th century and early 20th centuries with a host of new

technologies such as the X-ray, new medications and surgical procedures. Medical education

was soon subject to radical reform. In the United States, changing technology and higher

standards associated with the Flexner Report led to closure of many medical schools (Starr,

1982). Surviving medical schools faced expectations that were more rigorous. There was

debate in the early 20th century about appropriate qualifications for healthcare management.

Many thought that an MD with additional training in management was the preferred route. Non-

physician managers commonly held the position of superintendent with functions analogous to

hotel keeping. Many were women from nursing or the Catholic clergy (Arndt, 2010).

Physicians were sometimes contemptuous of “lay” managers who they thought would be unable

to lead or manage in the world of modern medicine (Snoke, 1987).

3

The Rockefeller Foundation was probably the first to sponsor study of healthcare management

education in 1922 and this work influenced establishment of the first undergraduate program at

Marquette University in Milwaukee in 1926. But, this program was short lived and closed after

two years due to weak demand for its graduates (Wren, 1980). Other universities experimented

with non-degree programs in the 1920s for hospital managers including Temple, Harvard and

New York University (Davis, 1929). The Rockefeller Foundation funded a second more

important study by Michael Davis published in 1929. It recommended a one-year curriculum of

education that included accounting, statistics, management and organization, economics, law,

public health, business policy and history. This was to be followed with a year of administrative

internship in a hospital setting.

The first full time graduate program in hospital administration was founded at the University of

Chicago in 1934 (Hartman, 1938). It was intended for students with previous experience and

was committed to a curriculum of serious study (Anderson, 1985). The program was housed in

the School of Business with close ties to the University Clinics. Michael Davis, who helped

establish the program, believed that this arrangement would provide for the necessary curriculum

but would also expose students to the culture and practice of providing health services (Davis,

1984). Physicians were encouraged to apply but few did. The success of the Chicago program

encouraged Northwestern University to establish a graduate program in healthcare management

in 1943. And similar to the University of Chicago, this was housed in the School of Commerce.

Interest in graduate healthcare management education increased after World War II. However,

not all agreed that it should be anchored in a school of business. Early leaders in the field saw

difficulties in placing healthcare management in business schools. Business schools were widely

seen as lacking academic rigor in the mid-20th century. It was feared this weakness might

4

undermine professionalization of the field. Moreover, the non-profit, physician-led tradition of

most hospitals was embedded in a culture quite different from that of business schools. There

was opposition to the bottom line orientation and instead, there was emphasis on external

benefits and the public goods nature of health services (Donabedian, 1972). There may have

been some concern about insufficient integration of physician control in business school culture.

Most business schools did not embrace a specialized concentration in healthcare management

and preferred a more generic approach to management education. This sentiment prevailed for

years and is only now changing as the health sector becomes more dominant and American

MBA programs differentiate in an environment of vigorous competition (Senft et al., 2008;

Chumney et al., 2008; Schultz, 2004).

The Hill-Burton Act of 1946 provided billions of dollars for hospital construction (Clark, 1980).

It also provided for long-term care and ambulatory facilities but most federal and other public

resources went to hospitals (Starr, 1982). Demand for hospital administrators was expected to

increase substantially. It was argued, with support from the Kellogg and Pew Foundations that

new healthcare management programs were needed and should be housed in health science

centers, especially schools of public health, in part to emphasize health specific content. For

example, in 1948 the Kellogg Foundation sponsored a report under the direction of Charles Prall

of the University of Pittsburg (Prall, 1948, Taylor, 1956). The Prall report was overseen by the

Joint Commission on Education of the American College of Hospital Administrators, which

consisted of fifteen members, nine of whom were physicians. The Joint Commission

participated in the establishment of six new hospital administration programs, five of which were

housed in schools of public health and the sixth in a medical school. The Association of

University Programs in Health Administration (AUPHA) was founded at this time to help

5

develop this emerging field. It was initially a small and informal organization consisting of

representatives from the relatively few, mostly health science center based programs that existed

at the time.

The first PhD program in Hospital and Health Administration was founded by Gerhard Hartman,

a graduate of the University of Chicago, at the University of Iowa in 1946. It was established as

a stand-alone program in the College of Medicine but developed ties with the College of

Business. Other doctoral programs followed but they have been fewer in number and with more

limited enrollment than masters programs. Healthcare management programs commonly employ

generalists trained in programs such as their own, but also rely heavily on those trained in social

science and management disciplines such as economics, sociology, management science and

organizational behavior.

In 1952, the Kellogg Foundation made a grant to the AUPHA to study and recommend

improvements for hospital and healthcare management education. The director of the study was

Herluf Olsen, a former Dean of the Amos Tuck School of Business Administration. In contrast

to the Prall Report, the Commission on University Education in Health Administration report

(1954) also known as the “Olsen Report” concluded that programs should be located in schools

of business but should afford considerable autonomy to develop their own curricula

(Commission on University Education in Health Administration, 1954). The Olsen Report

reviewed a dozen programs in the United States and Canada at Berkeley, Chicago, Columbia,

Iowa, Johns Hopkins, Minnesota, Northwestern, Pittsburg, Saint Louis, Toronto, Washington (in

Saint Louis) and Yale. Only two of these, Northwestern and Chicago were housed in business

schools.

6

Institutional Economics and Healthcare Management Education

Economic theory holds that behavior and performance follow from market structure and

incentives (Carlton and Perloff, 2005; Dafny, 2010). Structure and incentives differ markedly

between health science centers and business schools and this has led to variations in behavior.

Health science centers are financed primarily from patient revenues, grants and contracts. For

example, the 126 fully accredited US allopathic medical schools in fiscal 2010 received just 4

percent of their revenue from tuition and fees (Association of American Medical Colleges,

2011). Government and parent university support accounted for another 6 percent of revenue.

Even public medical schools received only 11 percent of revenue from state, local and

government support. Most revenue comes from other sources. Practice plans at public and

private medical schools generated 37 percent and grants and contracts provided another 30

percent of revenue. This is a very different financial foundation than commonly found in

schools of business. It has created a culture of reliance on faculty who generate patient or other

external revenues. The model works reasonably well for medical and biological education

(Mann, 2010). The model also works well for much of public health but can be problematic in

healthcare management education where many essential areas of expertise lack significant levels

of external funding.

Agency Theory

Institutional and evolutionary economics sheds light on the development of healthcare

management education, especially at health science centers. Institutional and evolutionary

economics are interdisciplinary. This school emphasizes historical and social factors including

causes of political relationships (Hodgson, 2000; Keil, 1998). An important pillar of institutional

7

thought is agency theory. It stresses lack of alignment of incentives between principals and

agents. This well-recognized concept is ubiquitous in social science and occurs in Adam

Smith’s work (Crowley and Sobel, 2010). It posits that principals, often consumers, have

objectives that agents can help meet with specialized expertise, access or other attributes useful

for carrying out a transaction. The agent however, may have incentives that lead to non-optimal

outcomes for the consumer. Agency theory has widespread application, used for example to

assess governance of Benedictine Abbeys (Rost, et al., 2010).

Agency theory has been found to be an important part of how physicians and hospitals behave

(Encinosa, Gaynor and Rebitzer, 2007; Forgione, Vermeer, et al., 2005). Health science centers

have an agency problem with respect to managerial education. Prioritization of patient and grant

revenue can jeopardize the management curriculum and scholarship because of scarcity of grant

or contract funding for management faculty salaries. Adherence to healthcare management

specific accreditation criteria has helped mitigate this problem. Core curriculum guidelines

developed by the Council on Accreditation of Healthcare Management Education (CAHME)

have included population health, policy, organization, operations, human resources, information

technology, law, governance, leadership, communications, statistics, economics, marketing,

finance, ethics, strategy, quality assessment and professional development (CAHME, 2011). On

the other hand, health science centers often rely on adjunct faculty or other imperfect substitutes

to teach management offerings. Business schools conform to a more traditional academic

structure. Financial incentives are better aligned with student orientation. Operational funding

is commonly associated with tuition, state subsidy or endowment funds. These resources are

used to maintain market levels of salary compensation. This facilitates alignment of faculty with

appropriate expertise and helps assure suitable curricula.

8

Rise of the MBA

Two reports published in 1959 sought to address the problem of insufficient rigor in business

schools. The Gordon and Howell Report funded by the Ford Foundation and the Pierson Report

funded by the Carnegie Foundation led to a revision of business school education (The

Economist, 2009). They found that business schools were undemanding and lacked adequate

grounding in theory. Students and faculty were determined to be of low caliber and there was

not enough emphasis on research or ethics. Business education was revamped in the years

following these watershed reports. Theory and quantitative techniques came to play a larger role

in the curriculum with faculty more engaged in research and scholarship. The image of business

schools improved as education became more abstract and theoretical (van Baalen and Karsten,

2010). Masters degrees awarded by business schools in the United States increased from 4,000

in 1949 to 168,000 in 2008-09 (Herrington, 2010; United States Department of Education, 2011).

Changes in business school curriculum spilled over to graduate healthcare management

education, especially the master in health administration (MHA). Curriculum changes occurred

with a shift from one year to two years of didactic education and a subsequent diminution of

practical experience such as hospital internships. The number of masters programs in healthcare

management increased significantly from the 1960s along with growth of the health sector. The

AUPHA listed 115 graduate programs in 2011, including four in Canada (AUPHA, 2011).

Seventy-two of these were full members accredited by CAHME. The remainder consists of

associate members without accreditation.

Description of Management Employment in Healthcare

9

Table 1 provides an estimate of managerial employment in healthcare from 2008 to 2018. The

Bureau of Labor Statistics (BLS) estimated there were 284,000 medical and health service

managers in the United States in 2008, 206,800 (74%) of whom worked in healthcare. The

remainder worked in other sectors such as insurance, consulting and government not shown in

Table 1. There are other related functions for managers in healthcare such as general

management, financial, human resource and health information systems management. The BLS

put the total number of managers in healthcare at about 615,000 in 2008. Growth of managerial

employment in healthcare of about 103,000 (17%) jobs was projected from 2008 to 2018. This

is faster than growth of all nonfarm employment expected to grow by 10 percent.

Table 1: Managerial Employment in Healthcare, 2008

Med & Hlth Ser Mngrs

CEOs / Gen Mngrs

Finance Mngrs / Spcialsts

HR Mngrs / Spcialsts

Comp & Info Sys Mngrs

All Other Total

Ambltry 65,900 45,000 25,400 17,200 1,600 43,000 198,100 Hospital 108,500 25,500 37,700 31,200 6,000 91,700 300,600 Nursing & Rsdntial

32,400 25,000 9,300 12,600 200 36,500 116,000

Total 206,800 95,500 72,400 61,000 7,800 171,200 614,700 Growth % 08 -18

17.8 6.8 / 10.2 15.6/ 19.9 13.3 / 26.9

28.5 15.4 16.8

Source: United States Bureau of Labor Statistics, 2011

The BLS data is useful and serves as a tool to monitor growth and change in healthcare

management employment, but tells us little about who is best qualified for these positions.

Higher education is an important, if not necessary, background for healthcare management

employment. Yet we have little data on where undergraduate management training is sufficient

10

or where and what kind of graduate level training is expected. Clinical backgrounds are

important for some positions but integration of clinical education with MBA and MHA level

education is insufficiently developed. For example, nursing has a long history of management

scholarship and practice not well recognized in business or public health schools (Meyer and

Bishop, 2007).

There are no licensure requirements for most healthcare managers in the United States, except in

nursing homes, unlike strict regulation of physicians, dentists, nurses, pharmacists and other

providers. This leads to a freer market for management talent. However, a master’s degree in

healthcare management or a related qualification has been a de facto prerequisite for

advancement to the most responsible administrative positions. Healthcare managers work in a

dynamic and rapidly changing environment. A wide range of competencies is desirable.

Business schools provide comparative advantage in core management topics and arguably better

prepare graduates for careers in healthcare finance, marketing and management information

systems. But health science center-based programs offer a greater familiarity with the culture

and operations of health services and may better prepare medical and health service managers.

They also provide a population-based perspective with courses in epidemiology and public

health that is important for health maintenance organizations (HMOs) and other organizations

managing care.

Differences in academic culture go beyond agency and financial incentives. Norms, values and

traditions vary substantially between business and health science academic settings. There are

historical and anthropological reasons for this. One theoretical perspective with explanatory

power embraces the demonstration effect. Demonstration theory was perhaps first popularized

in 1899 by Thorstein Veblen in the Theory of the Leisure Class (McCormick, 1983). Veblen put

11

an anthropological spin on economic behavior. He saw tendencies on the part of lower and

middle classes to emulate those at the apex of society. Others have argued that this occurs on a

global level with less developed countries seeking to emulate the habits and culture of the

wealthiest (Mason, 2000). This analysis can be extended to the health sector where a physician-

led culture evolved promoting not only the compensation and professional autonomy of

physicians, but also a wide range of secondary professions shaped in medical model with parallel

conformance belief systems. Early work in health economics found that hospitals served to

increase productivity and compensation of physicians at the expense of other stakeholders (Pauly

and Redisch, 1973).

Research that is more recent argues that the power structure of professional control in academic

medical centers is yielding to “managerial agency” with a different set of conformance standards

(Kitchner, 2002). This is shifting control from physicians to a new generation with more of a

business mindset. The organizational environment for physicians has been rapidly changing

with many more opting for salaried positions. There has been a sharp increase in hospital-owned

medical practices relative to physician-owned ones since 2005 (Harris, 2010). The increase is

attributed to the complexity of contracting with payers, developing information systems

including electronic health records and a desire for more regular working hours (Pham and

Ginsburg, 2008; Rittenhouse, Casalino et al., 2008). This shift has potential to promote better

integration of health services.

It is not clear how a change from physician professional control to a more nuanced managerial

approach will affect the financial model of health science centers relative to the more traditional

academic model of business schools. Academic health science centers also face another

important potential challenge. Less generous public funding of the life sciences through the

12

National Institutes of Health (NIH) and other federal agencies in response to fiscal pressure

threatens to undermine a financial paradigm that has been in place for decades. NIH funding

obligations increased from 780 million dollars in 1970 to 30.9 billion dollars in 2010, a 7-fold

increase in constant, inflation adjusted dollars (NIH, 2011; National Science Foundation, 2011).

Graduate Healthcare Management Education and Market Share

Figure 1 shows the changing mix of new members joining the American College of Healthcare

Executives from 1970 to 2010. The relative share held by those trained in business, health

science and other settings has been shifting. Graduates of business programs gained “market

share” among new members of the American College of Healthcare Executives (ACHE) until the

early 1990s. This share has been relatively steady since. Business graduates accounted for 24

percent of new members in 2010, whereas those with graduate degrees in health or hospital

administration accounted for 47 percent. The share held by graduates of health and hospital

administration programs has been in decline since 1970 when it accounted for 89 percent of new

members. Those with clinical training have been gaining market share in recent years. This

group includes graduates of nursing, medical and allied health programs. They accounted for 18

percent of new members in 2010. The ACHE is reasonably representative of healthcare

management but is somewhat weighted toward those with careers in hospitals where the masters

in hospital or health administration (MHA) has stronger roots. There is another reason Figure 1

understates market penetration of MBAs. Those with an MBA who also hold an MHA, MD or

other advanced clinical degree are classified in the latter categories.

13

Figure 1: New Members of the American College of Healthcare Executives, 1970-2010

Source: American College of Healthcare Executives (ACHE), 2010.

Graduate healthcare management education is diffuse and lacks a common voice. Most MBA

programs in healthcare are not associated with the AUPHA, perhaps for historical reasons. The

AUPHA was created in the wake of the Prall report, which leaned heavily toward building

management education capacity in health science centers. In addition, the accreditation earned

through the Accrediting Commission for Education of Health Services Administration

(ACHESA), which evolved into CAHME in 2004, may be of less importance to programs with

accreditation from The Association to Advance Collegiate Schools of Business (AACSB)

(Dalston, et al., 2005). Many MBA programs may not see a need to enhance their credibility in

14

the field of management and do not perceive it necessary to signal any health specific

competencies in this way (McKenna, Cotton, and Van Auken, 1997). It may also stem from a

lack of familiarity with the field. This lack of cohesion of academic settings has its benefits.

Fragmentation of healthcare management education facilitates a natural experiment in

management education (Rosenzweig and Wolpin, 2000). It provides insight about relative

strengths and weaknesses of rival approaches. On the other hand, this diffusion also undermines

academic healthcare management’s national impact on policy and other matters in an arena with

many powerful interest groups.

Asymmetric Information, Market Imperfection and Healthcare Management Education

Asymmetric information has been an important topic among economists for many years and is

central to agency theory (Sloman, 2006). It is seen as a major source of market imperfection

(Nalebuff and Stiglitz, 1983). Lack of information about prices, products, services and their

attributes including quality is often the norm. This is considered a form of market failure and

leads to economic inefficiency (Pauly, 1986; Mrozek, 1999). A wide range of institutions has

evolved in many sectors of the economy to cope with this problem. Kenneth Arrow’s 1963

article entitled “Uncertainty and the Welfare Economics of Medical Care” is an important

foundation in the field of health economics (Arrow, 1963; Haas-Wilson, 2001). Arrow argued,

among other things, that reliance on non-profit hospitals and deference to physicians results from

asymmetric information (Hall, 2001; Hammer, 2001). Society has placed trust in hospitals and

doctors regarding appropriate care because of necessity to defer to their judgment. This creates

vulnerability to induced demand, a phenomenon that health economists recognize but differ on

the extent of its magnitude (Liu and Mills, 2007).

15

Gaps in information extend to the market for healthcare management education. There is lack of

information about quality of healthcare management programs that best meet student needs. The

internet has improved access to information and rankings such as those provided by US World

and News Report have been important tools for shopping. Nevertheless, uncertainty remains.

This affords schools considerable latitude to market and shape perceptions of program attributes

(Schee, 2010). It can be difficult to determine the depth of expertise a program has in healthcare

management, particularly if students lack knowledge of AACSB, CAHME, and Council on

Education for Public Health (CEPH) accreditation criteria (AACSB, 2011, CAHME, 2011,

CEPH, 2011). There are many options available ranging from vocational to academic and from

business to health science settings. Universities offer traditional degrees as well as certificate

and executive programs. Many of the more vocationally-oriented programs are provided by for-

profit organizations, a relatively new element of healthcare management education (Parry, 2009).

For-profit universities have been expanding in the United States and their heavy reliance on

subsidized student loans has been especially controversial. The advent of for-profit healthcare

management education is an important development that warrants research. It may contribute to

a reversal of the trend towards conceptual abstraction and theory that took hold in the early and

mid-20th century.

Conclusion

There are advantages with both business and health science models of healthcare management

education. Business schools have been more oriented toward enrollment and health science

centers toward grant, contract and patient revenues. The former tends to insure a sound

management curriculum, but the latter can lead to poor faculty alignment with core management

course offerings. Health science centers do have comparative advantage in health-related

16

courses. Training for healthcare managers occurs in both settings. But, employers may have an

affinity for those with experiences similar to their own. They are likely to adhere to standards

they know and what others in respective professional communities do. The competition between

business schools and health science centers to produce managers will turn on how these

standards and institutions evolve.

Graduate healthcare management education has been a natural experiment. Business and health

science settings have been competing and evolving since the mid-20th century. The MHA has

yielded as the dominant qualification for higher-level healthcare management positions.

However, this evolution has not resulted in a clear verdict about which academic setting is

preferable, at least not yet. Surveys of preferences should be conducted to help understand why

relative preferences for the MBA and MHA exist as well as the related issue of which academic

and organizational setting is favored, business or health science. In addition, it would help to

have more research assessing the MBA and MHA relative to other graduate and professional

qualifications, especially for clinical fields. There are at least 15 MHA/MBA programs in the

United States. It would be helpful to know about the relative employability of graduates holding

both degrees. Finally, business schools have opportunities to serve clinical professionals that

should be more fully explored. Many physicians, nurses and other clinicians see the MBA as the

most desirable management degree. The rapid growth of PharmD/MBA programs in the United

States is evidence of this new market (Crismon et al., 2009).

Implementation of the Affordable Care Act of 2010 promises access to healthcare for millions

more Americans. The legislation has many provisions but much uncertainty remains about how

17

to curb costs. Public healthcare spending, accounting for 45 percent of national health

expenditures in 2010, has been increasing at unsustainable rates (Martin et al., 2011). This

threatens the creditworthiness of the United States. The United States must find ways to restrain

growth of Medicare, Medicaid and privately financed health insurance. More constrained

spending will affect healthcare management and education. To date, cost control has not been as

pressing an issue as is likely in the future. There has been relatively little need with third party

payment and insufficient price competition. The culture of healthcare management has focused

on service delivery and quality (Komashie, Mousavi and Gore, 2007). Physicians take an oath to

provide care when it benefits patients. There is no qualification stating that care should desist

when marginal cost exceeds marginal revenue. This is reflected in academia where management

and organization textbooks put inadequate emphasis on efficiency or cost control. For example,

two leading texts, White and Griffith (2010) and Burns, Bradley and Weiner (2012) provide no

more than one chapter each on either financial management or managing for efficiency or value,

a seemingly insufficient emphasis on perhaps the most important related task facing healthcare

managers, that of cost control. More integration of the concept and practice of efficiency are

expected and it remains to be seen which academic setting best excels at this task.

The evolution of graduate healthcare management in the United States and elsewhere has been

buffeted by competing cultures of business and medicine. Most countries retain a degree of

ambiguity about the nature of healthcare. Is it properly considered commerce or something else?

And what is the proper mix of public and private sectors? Few countries, if any, have arrived at

a satisfactory answer about how best to characterize healthcare. Countries other than the United

States are also marked by diffusion of healthcare management education across business and

18

health science settings. Faith in markets collides with social entitlements and the dignity of

human life rendering ambiguity about academic setting. Perhaps greater clarity will emerge

about appropriate academic settings for healthcare management education as health services

globalize and struggle to meet social expectations for more equitable and comprehensive care in

the face of serious resource constraints (Aaronson et al., 2010).

19

References

Aaronson, W., Counte, M., Ramirez, B. and West, D. (2010) “Global Health Management Education: Challenges and Opportunities for Academic Programs” Journal of Health Administration Education Vol 4, No 27, pp 323-325.

American Association for the Advancement of Colleges and Schools of Business (2011) AACSB Accreditation Standards http://www.aacsb.edu/accreditation/standards.asp accessed July 21, 2011.

American College of Healthcare Executives. (2010), Survey of Affiliates, Chicago

Anderson, O. (1985), “The History of the Graduate Program in Hospital Administration at the University of Chicago: a Case of Dynamic Marginality” Journal of Health Administration Education, Vol. 3 No. 2, pp. 5-25.

.Arndt, M. (2010), “Education and the Masculinization of Hospital Administration” Journal of Management History Vol. 16, No.1, pp. 75-89.

Arrow, Kenneth J. (1963), “Uncertainty and the Welfare Economics of Medical Care” American Economic Review, Vol. 53, No. 5, pp. 941-973.

Association of American Medical Colleges (2011), AAMC Data Book: Medical Schools and Teaching Hospitals by the Numbers, Chicago.

Association of University Programs in Health Administration (2011), List of Graduate-Level AUPHA Member Programs http://www.aupha.org/custom/directory/programs.cfm?progtype=Graduate accessed September 30, 2011.

Burns, L., Bradley, E., and Weiner, B. (2012), Shortell and Kaluzny’s Health Care Management: Organizational Design and Behavior, Sixth Edition, Delmar Cengage Learning, Clifton Park, New York.

Carlton, D. and Perloff, J. (2005) Modern Industrial Organization, Prentice Hall, Upper Saddle River, New Jersey.

Chevallier, J. (2011) “L’arrivée de la Grosse Verole à l’Hôtel-Dieu de Lyon” Histoire des Sciences Médicales Vol. 42, No. 1, pp 29-38.Chumney, E., Ragucci, K. and Jones, K. (2008),

20

“Impact of a Dual PharmD/MBA on Graduates’ Academic Performance, Career Opportunities, and Earning Potential”, American Journal of Pharmaceutical Education Vol.72 No.2, pp. 1-6.

Clark L., Field M., Koontz T., Koontz V. (1980) “The Impact of Hill-Burton: An Analysis of Hospital Bed and Physician Distribution in the United States, 1950-1970” Medical Care Vol. 18, No. 5, pp. 532-550.

Commission on University Education in Hospital Administration (1954), University Education for Administration in Hospitals. American Council on Education, Washington D.C.

Commission on Accreditation of Healthcare Management Education (2011) Criteria for Accreditation:http://www.cahme.org/Resources/OfficialCAHMECriteria_Fall2010_Beyond_revMay2009.pdf accessed July 21, 2011.

Council on Education for Public Health (2011), Accreditation Criteria http://www.ceph.org/pg_accreditation_criteria.htm accessed July 21, 2011.

Crismon, M.L., Albright, F., Canney, D., Das, N., Mehanna, A., Welage, L. Wu-Pong, S. and Miller, K. (2009), “The Role of Dual-Degree Program in Colleges and Schools of Pharmacy: The Report of the 2008-09 Research and Graduate Affairs Committee” American Journal of Pharmaceutical Education Vol. 17 No. 8, Article S6, pp. 1-10.

Crowley, G. and Sobel, R. (2010) “Adam Smith: Managerial Insights from the Father of Economics” Journal of Management History Vol. 16. No. 4, pp. 504-508.

Dafny, L. (2010) “Are Health Insurance Markets Competitive?” American Economic Review Vol. 100 No. 4, pp. 1399-1431.

Dalston, J., Prybil, L. Berman, H. and Lloyd, J. (2005) “Transforming the Accreditation of Health Care Management Education” Inquiry Vol.42 pp. 320-334.

Davis, M. (1929), Hospital Administration: A Career, Rockefeller Foundation, New York.

Davis, M. (1984) Development of the First Graduate Program in Hospital Administration. Journal of Health Administration Education, Vol.2 No. 2, pp. 121-134.

Donabedian, A. (1972), Aspects of Medical Care Administration: Specifying Requirements for Health Care, Harvard University Press, Cambridge, Massachusetts.

Dunn, R. (2010) Dunn & Haimann’s Healthcare Management, Ninth Edition, Health Administration Press, Chicago.

21

Encinosa III, W., Gaynor, M. and Rebitzer, J. (2007) “The Sociology of Groups and Economics of Incentives: Theory and Evidence on Compensation Systems”, Journal of Economic Behavior and Organization Vol. 62 No. 2, pp. 187-214.

Forgione, D., Vermeer, T, Krishnamurthy, S., Wrieden, J. and Plante, C. (2005) “DRGs, Costs and Quality of Care: An Agency Theory Perspective” Financial Accountability and Management Vol. 21 No. 3, pp. 291-308.

Hall, M. (2001) “Arrow on Trust” Journal of Health Politics, Policy and Law Vol. 26, No. 5, pp. 1131-1144.

Hammer, P. (2001) “Arrow’s Analysis of Social Institutions: Entering the Marketplace with Giving Hands?” Journal of Health Politics, Policy and Law Vol. 26 No.5, pp. 1081-1098.

Harris, G. (2010) “More Doctors Giving Up Private Practices” New York Times, March 25.

Hartman, G. (1938) “Graduate Education in Hospital Administration 1934-37” Journal of Business, Vol.11, No. 4, pp. 363-375.

Haas-Wilson, D. (2001) “Market Failure in Health Care: The Changing Content and Sources of Health Care Information” Journal of Health Politics, Policy and Law Vol. 26 No. 5, pp. 1031-1044.

Herrington, J.D. (2010) “MBA: Past, Present and Future” Academy of Educational Leadership Journal Vol. 14 No. 1, pp. 1-8.

Hodgson, G. (2000) “What is the Essence of Institutional Economics?” Journal of Economic Issues Vol.34 No. 2, pp. 317-329.

Kiel, J. (1998) “Understanding and Managing Physician Restructuring through Organizational Theory” International Journal of Organizational Theory and Behavior Vol. 1 No 1, pp. 117-127.

Kitchner, M. (2002) “Mobilizing the Logic of Managerialism in Professional Fields: The Case of Academic Health Centre Mergers” Organizational Studies Vol. 23 No. 3, pp. 391-420.

Komashie, A., Mousavi, A., and Gore, J. (2007) “Quality Management in Healthcare and Industry: A Comparative Review and Emerging Themes” Journal of Management History Vol. 13 No. 4, pp. 359-370.

22

Levey, S., Hilsenrath, P. and Hill, J. (1998) “Dilemmas in Health Management Education: Past, Present and Future” Journal of Health Administration Education Vol. 16 No. 1, pp. 67-85.

Liu, X. and Mills, A. (2007) “Supplier Induced Demand and Unnecessary Care” in Preker, A, Liu, X., Velenyi E.V. and Baris, E. (ED), Public Ends, Private Means: Strategic Purchasing of Health Services, World Bank, Washington D.C.

Mann, K. (2010) “Self-Assessment: The Complex Process of Determining “How We Are Doing” – A Perspective from Medical Education” Academy of Management Learning and Education Vol. 9 No. 2, pp. 305-313.

Martin, A., Lassman, D., Whittle, L., Catlin, A. and the National Health Expenditures Accounts Team (2011) “Recession Contributes to Slowest Annual Rate of Increase in Health Spending in Five Decades” Health Affairs Vol. 30 N0 1, pp. 11-22.

Mason, R. (2000), “The Social Significance of Consumption: James Duesenberry's Contribution to Consumer Theory” Journal of Economic Issues, Vol. 34 No. 3, pp. 553–572.

McCormick, K. (1983), “Duesenberry and Veblen: The Demonstration Effect Revisited” Journal of Economic Issues Vol.17 No. 4, pp. 1125-1129.

McKenna, J., Cotton, C. and Van Auken, S. (1999), “The New AACSB Accreditation Standards: a Prospect of Tiering?” Journal of Organizational Change Management Vol. 10 No. 6, pp. 491-502.

Meyer, B. and Bishop, D. (2007), “Florence Nightingale: A Nineteenth Century Apostle of Quality” Journal of Management History Vol. 13, No. 3, pp. 240-254.

Miller, T. (1978) “The Knights of Saint John and the Hospitals of the Latin West” Speculum Vol. 53, No. 4, pp. 709-733.

Mrozek, J. (1999), “Market Failures and Efficiency in the Principles Course” Journal of Economic Education Vol. 30 No. 3, pp. 411-419.

Nalebuff, B. and Stiglitz, J. (1983), “Information, Competition and Markets” American Economic Review Vol. 73 No. 2, pp. 278-283, Papers and Proceedings.

National Institutes of Health (2011), Actual Obligations, by Institute and Center FY 98-FY2010. http://officeofbudget.od.nih.gov/pdfs/FY12/Actual%20Obligations%20by%20IC%201998-2010.pdf accessed July 21, 2011.

23

National Science Foundation (2011), Federal Obligations for Total Research, by Detailed Field of Science & Engineering: HHS, National Institutes of Health, Fiscal Years 1970-1998, http://www.nsf.gov/statistics/nsf98326/pdf/ff46fos1.pdf, accessed July 21, 2011.

O’Leary, K. (2008), “The Evolution and Future of Hospital Medicine” Mount Sinai Journal of Medicine Vol. 75 No. 5, pp. 418-423.

Parry, M. (2009), “With Typical Vigor, Jack Welch Set Out to Upend Online Business Education” Chronicle of Higher Education Vol. 56, No. 11, pp. A14-A16.

Pauly, M. and Redisch, M. (1973), “The Not-For-Profit Hospital as a Physician’s Cooperative” American Economic Review Vol. 63 No. 1, pp. 87-100.

Pauly, M. (1986), “Taxation, Health Insurance and Market Failure in the Medical Economy” Journal of Economic Literature Vol.24 No. 2, pp. 629-675.

Pham, H. and Ginsburg, P. (2007), “Unhealthy Trends: The Future of Physician Services” Health Affairs, Vol. 26 No. 6, pp. 1586-1598.

Prall, C. (1948), The College Curriculum in Hospital Administration, Physicians Record Company, Chicago.

Risse, G. (1999) Mending Bodies, Saving Souls: A History of Hospitals, Oxford University Press, New York.

Rittenhouse, D., Casalino, L., Gillies, R., Shortell, S., Lau, B. (2008), “Measuring the Medical Home Infrastructure in Large Medical Groups” Health Affairs Vol. 27 No. 5, 1246-1258.

Rosenzweig, M. and Wolpin, K. (2000), “Natural “Natural Experiments” in Economics” Journal of Economic Literature Vol. 38 No. 4, pp. 827-874.

Rost, K., Inauen, E., Osterloh, M. and Frey, B. (2010), “The Corporate Governance of Benedictine Abbeys: What Can Stock Corporations Learn from Monasteries?” Journal of Management History Vol. 16, No. 1. pp. 90-115.

Schee, B. (2010), “The Small College Enrollment Officer: Relationship Marketing at Work” Journal of Marketing for Higher Education Vol. 20 No. 1, pp. 135-143.

Schultz, F. (2004), “Who Should Lead a Healthcare Organization: MDs or MBAs?” Journal of Healthcare Management Vol. 49 No. 2, pp. 103-116.

Senft, S. Thompson, C. and Blumenschein, K. (2008), “Dual Degree Programs at the University of Kentucky College of Pharmacy” American Journal of Pharmaceutical Education Vol. 72 No. 1, pp. 1-11.

24

Sloman, J. (2006), “Asymmetric Information and Market Failure” Teaching Business and Economics Vol. 10 No. 3, pp. 11-12.

Snoke, A. (1987), Hospitals, Health and People, Yale University Press, New Haven, Connecticut.

Starr, P. (1982), The Social Transformation of American Medicine. Basic Books, New York.

Taylor, K. (1956) “A Pre-Administration Curriculum in a School of Public Health” Public Health Reports Vol. 71 No.4, pp. 391-394.

Thomasson, M. (2002) “From Sickness to Health: The Twentieth-Century Development of U.S. Health Insurance” Explorations in Economic History Vol. 39 No. 3, pp. 233-253.

The Economist. (2009), “The Gordon-Howell Report of 1959: The More Things Change… A Seminal Critique of American Business Education, Five Decades On” June 4.

United States Bureau of Labor Statistics (2011), 2008-2018 National Employment Matrix, Occupational Employment by Industry http://www.bls.gov/emp/ep_table_109.htm accessed July 21, 2011.

United States Department of Education, National Center for Education Statistics, 1998–99 and 2008–09 Integrated Postsecondary Education Data System, "Completions Survey" (IPEDS-C:99) and Fall 2009 http://nces.ed.gov/programs/coe/indicator_gfs.asp accessed July 22, 2011.

Van Baalen, P. and Karsten, L. (2010) “The Social Shaping of Early Business Schools in the Netherlands” Journal of Management History Vol. 16 No. 2, pp. 153-173.

White, K. and Griffith J.(2010) The Well-Managed Healthcare Organization, Seventh Edition, Health Administration Press, Chicago.

Wren, G. (1980), An Historical View of Health Administration Education, Hospital and Health Services Administration. Vol. 25 No.3, pp. 31-42.