Is provider capitation working? Effects on physician-hospital integration and costs of care
Is provider capitation working? Effects on physician-hospital integration and costs of care
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DOI：
10.1097/00005650-200003000-00008
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发表时间：
2000-03-01
期刊：
影响因子：
3
通讯作者：
Lindrooth, R
中科院分区：
文献类型：
--
作者：
Bazzoli, GJ;Dynan, L;Lindrooth, R
背景：按人头计价要求卫生服务提供者对他们所提供或安排的服务负有财务责任，从而为医生和医院整合活动和降低护理成本提供了强大的动力。目的：本研究的目的是评估按人头计价对医院和医生之间的功能、财务和临床流程整合的两个潜在影响，以及(2)其结合流程整合对医院成本的影响。我们研究了1995年美国医院协会(AHA)的一项特别调查，该调查包含44种不同的医生-医院一体化活动的信息，以及管理服务组织、医生-医院组织和其他类似实体持有的全球资本合同的信息。这些数据与AHA的医院年度调查、InterStudy HMO数据、区域资源文件和州法规数据相结合。使用多变量分析来评估自理能力和整合之间的关系，然后检验这些因素和其他因素对医院成本的影响。我们研究了319家拥有完整数据的城市医院。研究发现，FINDINGS提供商头衔在行政/执业管理、医生财务风险分担、合资创建新服务、计算机连接以及医生与医院一体化的总体衡量方面促进了医院和医生之间的整合。然而，整合和按人头计价对医院成本的预期效果并不明显。结论：全球按人头计价在许多方面促使医生和医院之间更紧密的整合。虽然按人头计价目前起到了鼓励流程整合的中间效果，但它还没有达到降低医院成本的最终预期效果。
BACKGROUND, Capitation holds health providers fiscally responsible for the services they deliver or arrange and thus provides strong motivation for physicians and hospitals to integrate activities and reduce costs of care.OBJECTIVES. The objective of this study was to assess 2 potential effects of capitation: (1) its effects on the integration of functional, financial, and clinical processes between hospitals and physicians and (2) its effects, in conjunction with process integration, on hospital costs.STUDY DESIGN. We studied a 1995 American Hospital Association (AHA) special survey that has information on 44 different physician-hospital integrative activities and on global capitation contracts held by management service organizations, physician-hospital organizations, and other similar entities. These data were combined with the AHA's Annual Survey of Hospitals, InterStudy HMO data, the area resource file, and state regulation data. Multivariate analysis was used to assess the relationship between capitation and integration and then to examine the influence of these factors and others on hospital costs. We studied 319 urban hospitals with complete data.FINDINGS. provider capitation was found to promote integration between hospitals and physicians in relation to administrative/practice management, physician financial risk sharing, joint ventures to create new services, computer linkages, and an overall measure of physician-hospital integration. However, anticipated effects of integration and capitation on hospital costs were not evident.CONCLUSION. Global capitation is motivating tighter integration between physicians and hospitals in a number of respects. Although capitation is currently having the intermediate effect of encouraging process integration, it is not yet having the ultimate anticipated effect of lowering hospital costs.