Cost of Inpatient Care and its Association with Hospital Competition
Cost of Inpatient Care and its Association with Hospital Competition
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DOI：
10.1016/j.jamcollsurg.2010.09.014
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发表时间：
2011-01-01
影响因子：
5.2
通讯作者：
Abdullah, Fizan
中科院分区：
文献类型：
--
作者：
Chang, David C.;Shiozawa, Aki;Abdullah, Fizan
背景：传统的经济原理表明，竞争的加剧与价格的下降有关。本研究的目的是通过分析成本变化应最小化的标准化操作，确定医院竞争的客观衡量标准与总费用之间的关联是否成立。 研究设计：医院市场结构文件（来自医疗保健研究和质量机构，可用于 2000 年和 2003 年）与全国住院患者样本数据库链接。在排除可能出现并发症的患者后，对阑尾切除术、颈动脉内膜切除术、减肥手术、根治性前列腺切除术和幽门肌切开术进行了分析。主要结局包括住院总费用。主要自变量是赫芬达尔-赫希曼指数 (HHI)，由医疗保健研究和质量局根据每家医院的患者流量市场计算得出。 HHI 较高代表市场上存在更占优势的医院或较低的竞争。 结果：对来自 1,492 家医院的 162,823 名患者（85,791 例阑尾切除术、38,619 例颈动脉内膜切除术、18,383 例减肥手术、16,784 例根治性前列腺切除术、3,246 例幽门肌切开术）进行了分析。单线性回归分析表明，在所有情况下，较高的 HHI 与较低的医院总费用显着相关。在多变量分析中，HHI 增加 1 个百分点与阑尾切除术 - 114 美元、颈动脉内膜切除术 - 163 美元和根治性前列腺切除术 - 193 美元相关（所有 p
BACKGROUND: Conventional economic principles suggest that increases in competition are associated with price decreases. The purpose of this study is to determine whether this association holds true between objective measures of hospital competition and gross charges, by analyzing standardized operations where variations in costs should be minimal.STUDY DESIGN: Hospital Market Structure file (from Agency for Healthcare Research and Quality, available for years 2000 and 2003) was linked to Nationwide Inpatient Sample database. Appendectomy, carotid endarterectomy, bariatric surgery, radical prostatectomy, and pyloromyotomy were analyzed, after excluding patients with possible complications. Primary outcomes included total hospital charges. Primary independent variable was Herfindahl-Hirschman Index (HHI) calculated by the Agency for Healthcare Research and Quality for each hospital based on its patient-flow market. Higher HHI represents the presence of more dominant hospitals in the market or lower competition.RESULTS: A total of 162,823 patients from 1,492 hospitals (85,791 appendectomies, 38,619 carotid endarterectomies, 18,383 bariatric operations, 16,784 radical prostatectomies, 3,246 pyloromyotomies) were analyzed. Single linear regression analyses demonstrated higher HHI was significantly associated with lower hospital gross charges in all cases. On multivariate analysis, a 1 percentage-point increase on HHI was associated with -$114 for appendectomy, -$163 for carotid endarterectomy, and -$193 for radical prostatectomy (all p