Competition, payers, and hospital quality
Competition, payers, and hospital quality
复制标题
DOI：
10.1111/j.1475-6773.2003.00185.x
复制
发表时间：
2003-12-01
影响因子：
3.4
通讯作者：
Town, RJ
中科院分区：
文献类型：
--
作者：
Gowrisankaran, G;Town, RJ
Objective.估计医疗保险和HMO患者的竞争对南加州医院质量决策的影响。数据来源。1989- 1993年期间来自加州全州卫生规划和发展办公室的二级出院数据。研究设计。结果变量是肺炎（作者估计）和急性心肌梗死（AMI）（加州州报告）的风险调整后的住院死亡率。竞争的措施是为每个医院和付款人类型。制定竞争措施是为了减少内部歧视的可能性。风险调整后的死亡率和不同的竞争措施之间的关系估计使用普通最小二乘法。该研究发现，对健康维护组织（HMO）患者的竞争程度增加与风险调整后的医院死亡率下降有关。相反，医疗保险注册者竞争的增加与医院风险调整死亡率的增加相关。结合以前的研究，估计表明，HMO患者的竞争越来越激烈，似乎降低了价格，挽救了生命，因此似乎改善了福利。然而，医疗保险竞争的增加似乎会降低质量，并可能减少福利。在我们的样本中，竞争加剧对医院质量的净影响很小。
Objective. To estimate the effects of competition for both Medicare and HMO patients on the quality decisions of hospitals in Southern California.Data Source. Secondary discharge data from the Office of Statewide Health Planning and Development for the State of California for the period 1989-1993.Study Design. Outcome variables are the risk-adjusted hospital mortality rates for pneumonia (estimated by the authors) and acute myocardial infarction (AMI) (reported by the state of California). Measures of competition are constructed for each hospital and payer type. The competition measures are formulated to mitigate the possibility of endogeneity bias. The relationships between risk-adjusted mortality and the different competition measures are estimated using ordinary least squares.Principal Findings. The study finds that an increase in the degree of competition for health maintenance organization (HMO) patients is associated with a decrease in risk-adjusted hospital mortality rates. Conversely, an increase in competition for Medicare enrollees is associated with an increase in risk-adjusted mortality rates for hospitals.Conclusions. In conjunction with previous research, the estimates indicate that increasing competition for HMO patients appears to reduce prices and save lives and hence appears to improve welfare. However, increases in competition for Medicare appear to reduce quality and may reduce welfare. Increasing competition has little net effect on hospital quality in our sample.