Updated variable-radius measures of hospital competition
Updated variable-radius measures of hospital competition
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DOI：
10.1111/j.1475-6773.2004.00235.x
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发表时间：
2004-04-01
影响因子：
3.4
通讯作者：
Escarce, JJ
中科院分区：
文献类型：
--
作者：
Gresenz, CR;Rogowski, J;Escarce, JJ
Objective.计算医院市场规模的可变半径度量，并创建医院市场竞争度量。数据来源。出院摘要来自1997年国家住院病人数据库的医疗保健成本和利用项目（HCUP）与美国医院协会（AHA）年度调查，地区资源文件（ARF），InterStudy区域市场分析数据库，和医疗保险的预期支付系统影响文件。医院半径捕获75%和90%的入院率回归医院和医疗保健市场的特点和其他当地的特点，规范的目的是最大限度地提高预测能力。竞争医院的数量和赫芬达尔-赫希曼竞争指数（HHI）计算每个医院的市场。出院摘要被用来创建九个州的医院的实际半径。这些数据与描述医院、医疗保健市场和其他特征的其他数据相关联。我们分别解释了城市和农村医院中44.7%和9.6%的变化，在半径上捕获了90%的患者，在半径上捕获了75%的患者。人口密度;其他医院在当地的数量;和医院的特点，如医学院的附属机构，是医疗补助，病例组合和服务提供的入院比例是医院的市场规模的重要相关因素。为美国大陆所有非联邦、短期、普通内科/外科医院创建了预测半径和相关竞争措施（与AHA医院标识符匹配），这些医院的完整数据可在1997年获得（N= 4，806），作者可提供。
Objective. To calculate variable-radius measures of hospital market size and create measures of competition for hospitals' markets.Data Sources. Discharge abstracts from the 1997 State Inpatient Databases of the Healthcare Cost and Utilization Project (HCUP) linked with the American Hospital Association (AHA) Annual Survey, Area Resource File (ARF), InterStudy Regional Market Analysis database, and Medicare's Prospective Payment System Impact Files.Study Design. Hospital radii capturing 75 and 90 percent of hospital admissions regressed against hospital and health care market characteristics and other local area characteristics, where the specification was designed to maximize predictive ability. The number of competing hospitals and the Herfindahl-Hirschman index (HHI) of competition were calculated for each hospital's market.Data Collection Methods. Discharge abstracts were used to create actual radii for hospitals in nine states. These data were linked with other data describing hospital, health care market, and other characteristics.Principal Findings. We explained 44.7 and 9.6 percent of the variation among urban and rural hospitals, respectively, in radii that capture 90 percent of patients, and slightly less of the variation in radii that capture 75 percent of patients. Population density; number of other hospitals in the local area; and hospital characteristics such as medical school affiliation, percentage of admissions that are Medicaid, case mix, and service offerings are important correlates of a hospital's market size.Conclusions. Predicted radii and associated competition measures were created (matched to AHA hospital identifiers) for all nonfederal, short-term, general medical/ surgical hospitals in the continental United States for which complete data were available in 1997 (N= 4,806) and axe available from the authors.