Georgia rural hospital authorities as “shadow governments”

Purpose: The tenuous financial viability of many of Georgia’s rural hospitals has driven increased scrutiny of the hospital authorities (HAs) that own and govern them. HAs are a type of “special district” established in state law to allow for specialization of function, while evading statutes that can limit local government borrowing and multi-year contracts. The paper aims to discuss this issue. Design/methodology/approach: This paper uses a case example to introduce transparency and accountability in one local Georgia hospital and expands to include a descriptive analysis of transparency measures in 29 rural Georgia HAs. Findings: Findings indicate that, like many other special districts in Georgia and the USA, Georgia’s rural HAs often act more like private entities than the public organizations they are. The lack of transparency demonstrated in this sector limits access to public information and reduces opportunities for citizen engagement, a necessary component of representative institutions. Research limitations/implications: This case study is limited to Georgia HAs; however, the data support the lack of accountability and transparency found in many special district governments. Originality/value: The lack of transparency in all of the organizations reviewed in this study demonstrates blurred lines between between public matters and private interests and raises questions of transparency, a key value in democracies.