A national study of efficiency for dialysis centers: an examination of market competition and facility characteristics for production of multiple dialysis outputs.
A national study of efficiency for dialysis centers: an examination of market competition and facility characteristics for production of multiple dialysis outputs.
复制标题
全国透析中心效率研究：对多种透析产品生产的市场竞争和设施特征的检查。
作者：
H. Ozgen;Y. Ozcan
目的
从产业组织模型的角度，研究与生产多种透析产品的技术效率相关的市场竞争和设施特征。
研究环境
1997年运营的独立透析设施向卫生保健融资管理局（HCFA）提交了成本报告表格，并提供了所有三项产出-门诊透析、透析培训和家庭计划透析。
数据源
利用HCFA的独立肾脏机构成本报告数据文件（IRFCRD）获得791家多输出机构的输出和输入变量以及市场和机构特征的信息。有关人口特征的信息来自地区资源文件。
研究设计
利用1997年的横截面数据，通过数据包络分析（DEA）估计获得设施特定的技术效率得分。一个二元变量的效率状态，然后回归其市场和设施的特点和控制因素的多元逻辑回归分析。
主要调查结果
样本中的大多数设施在技术上运作效率低下。无论是市场竞争的激烈程度，还是透析器重复使用的政策，都不会对设施的效率产生重大影响。然而，技术效率与所有权类型、营利性市场集中度与所有权类型之间的相互作用以及与不同规模的连锁店的关系密切相关。非营利和政府拥有的设施比营利性设施更有可能成为肾透析产出的低效率生产者。另一方面，随着营利性企业在特定市场的市场集中度增加，所有制形式与效率之间的关系发生逆转。属于大型连锁店的设施在技术上更有可能效率低下。
结论
设施似乎没有从联合生产各种透析输出中受益，这可能解释了单一输出生产的持续趋势。所有制形式确实对生产效率有积极的影响，但仅限于非营利和营利设施之间存在竞争的地方市场。与大型连锁店的成员资格相关的日益增加的低效率表明，透析行业的日益整合实际上可能不是在生产多种透析产品时实现更高技术效率的策略。
OBJECTIVE
To examine market competition and facility characteristics that can be related to technical efficiency in the production of multiple dialysis outputs from the perspective of the industrial organization model.
STUDY SETTING
Freestanding dialysis facilities that operated in 1997 submitted cost report fonns to the Health Care Financing Administration (HCFA), and offered all three outputs--outpatient dialysis, dialysis training, and home program dialysis.
DATA SOURCES
The Independent Renal Facility Cost Report Data file (IRFCRD) from HCFA was utilized to obtain information on output and input variables and market and facility features for 791 multiple-output facilities. Information regarding population characteristics was obtained from the Area Resources File.
STUDY DESIGN
Cross-sectional data for the year 1997 were utilized to obtain facility-specific technical efficiency scores estimated through Data Envelopment Analysis (DEA). A binary variable of efficiency status was then regressed against its market and facility characteristics and control factors in a multivariate logistic regression analysis.
PRINCIPAL FINDINGS
The majority of the facilities in the sample are functioning technically inefficiently. Neither the intensity of market competition nor a policy of dialyzer reuse has a significant effect on the facilities' efficiency. Technical efficiency is significantly associated, however, with type of ownership, with the interaction between the market concentration of for-profits and ownership type, and with affiliations with chains of different sizes. Nonprofit and government-owned Facilities are more likely than their for-profit counterparts to become inefficient producers of renal dialysis outputs. On the other hand, that relationship between ownership form and efficiency is reversed as the market concentration of for-profits in a given market increases. Facilities that are members of large chains are more likely to be technically inefficient.
CONCLUSIONS
Facilities do not appear to benefit from joint production of a variety of dialysis outputs, which may explain the ongoing tendency toward single-output production. Ownership form does make a positive difference in production efficiency, but only in local markets where competition exists between nonprofit and for-profit facilities. The increasing inefficiency associated with membership in large chains suggests that the growing consolidation in the dialysis industry may not, in fact, be the strategy for attaining more technical efficiency in the production of multiple dialysis outputs.
比较替代模型在评估 HMO 效率方面的一致性。
影响因子：
3.4
作者：
Bryce,CL;Engberg,JB;Wholey,DR
通讯作者：
Wholey,DR
影响血液透析设施的可用性和使用的因素。
影响因子：
--
作者：
Cleary,PD;Schlesinger,M;Blumenthal,D
通讯作者：
Blumenthal,D
透析器重复使用对血液透析患者生存的影响。
DOI：
--
发表时间：
1996
期刊：
JAMA : the journal of the American Medical Association
影响因子：
--
作者：
Feldman,HI;Kinosian,M;Bilker,WB;Simmons,C;Holmes,JH;Pauly,MV;Escarce,JJ
通讯作者：
Escarce,JJ