Assistant Professor Minyoung Ku, Ph.D., of FSU’s Reubin O’D. Askew School of Public Administration & Policy at Florida State University was the lead author of “Where do uninsured patients go? The paradox of collaborative network dynamics in interhospital transfers” published in Social Science & Medicine in May 2026, with fellow researchers FSU doctoral student Jinyoung Cha, and Arnold L. & Priscilla Moss Greenfield Endowed Professor Keon-Hyung Lee, Ph.D. The study examines the subtle ways that interhospital collaboration dynamics shape where patients are transferred, with a focus on differences across payer groups. The following summary was written by Emily Harris (B.S. Psychology & Creative Writing ’28)
Assistant Professor Minyoung Ku, Ph.D., of FSU’s Reubin O’D. Askew School of Public Administration & Policy at Florida State University was the lead author of “Where do uninsured patients go? The paradox of collaborative network dynamics in interhospital transfers” published in Social Science & Medicine in May 2026, with fellow researchers FSU doctoral student Jinyoung Cha, and Arnold L. & Priscilla Moss Greenfield Endowed Professor Keon-Hyung Lee, Ph.D. The study examines the subtle ways that interhospital collaboration dynamics shape where patients are transferred, with a focus on differences across payer groups.
To study this topic, the team analyzed daily inpatient transfers among 159 general acute-care hospitals in Florida from 2018 through 2021, using Relational Event Modeling (REM), a method that captures how relationships between hospitals develop and change over time, to evaluate how the interhospital collaboration dynamics differed between insured and uninsured patients.
“My research helps to advance our understanding of how patient transfer systems work, from identifying empirical patterns of transfers to revealing the mechanisms behind them, bridging theoretical perspectives from multiple disciplines, including organization management, public policy, sociology, and public health,” Dr. Ku said. “Theoretically, the study also extends the discussion of the ‘dark sides’ of social capital and embeddedness into the domain of public value creation in healthcare, by showing that different stories may emerge when we look at seemingly well-operating systems from a different, more systemwide perspective.”
The team hypothesized that the relationship patterns that bind hospitals together, such as repeat partnerships and referrals through shared contacts, operate differently for uninsured patients, who are more likely to be routed away from well-connected hospital groups.
Ultimately, the team found that interhospital transfer networks do not operate equally and instead work differently depending on the patient’s insurance status. They systematically route uninsured patients away from well-established groups of hospitals that ordinarily handle transfers among themselves.
“I think there’s real value in researchers working more closely with hospitals and policymakers on this. It’s one thing to show that the structure of these networks affects where patients end up, based on non-clinical factors. But how this happens can be subtle and emergent, not easily visible even to the people working inside the system,” Dr. Ku said. “Making sense of that and starting to think about what to do about it, will require future research that works in close partnership with the hospitals and policymakers whose decisions really matter for how these systems work.”
To read the full extent of the teams’ research, visit www.sciencedirect.com/science/article/abs/pii/S0277953626001772.