Vertical Integration: Hospital Ownership Of Physician Practices Is Associated With Higher Prices And Spending
Vertical Integration: Hospital Ownership Of Physician Practices Is Associated With Higher Prices And Spending
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DOI：
10.1377/hlthaff.2013.1279
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发表时间：
2014-05-01
期刊：
影响因子：
9.7
通讯作者：
Kessler, Daniel P.
中科院分区：
文献类型：
--
作者：
Baker, Laurence C.;Bundorf, M. Kate;Kessler, Daniel P.
我们研究了医院和医生执业之间的合同或所有权关系的后果，通常被描述为垂直整合。这种整合可以通过改善护理机构之间的沟通来减少医疗支出并提高护理质量，但它也可以增加提供者的市场力量，并促进支付因不当转诊而产生的有效回扣。我们调查了垂直整合对医院价格、数量（入院人数）和私人保险患者支出的影响。利用 Truven Analytics MarketScan 为 2001-07 年期间非老年私人保险的医院索赔，我们构建了县级价格、数量和支出指数，并根据参保者的年龄和性别进行了调整。我们利用美国医院协会关于医院与医生关系类型的信息来衡量医院与医生的融合。我们发现，与医生垂直整合关系最紧密（医生执业所有权）的医院市场份额的增加与医院价格和支出的上涨有关。我们发现，合同一体化的增加减少了住院频率，但这种影响相对较小。总而言之，我们的结果从私人被保人的角度提供了一幅混合但有些负面的垂直整合图景。
We examined the consequences of contractual or ownership relationships between hospitals and physician practices, often described as vertical integration. Such integration can reduce health spending and increase the quality of care by improving communication across care settings, but it can also increase providers' market power and facilitate the payment of what are effectively kickbacks for inappropriate referrals. We investigated the impact of vertical integration on hospital prices, volumes (admissions), and spending for privately insured patients. Using hospital claims from Truven Analytics MarketScan for the nonelderly privately insured in the period 2001-07, we constructed county-level indices of prices, volumes, and spending and adjusted them for enrollees' age and sex. We measured hospital-physician integration using information from the American Hospital Association on the types of relationships hospitals have with physicians. We found that an increase in the market share of hospitals with the tightest vertically integrated relationship with physicians-ownership of physician practices-was associated with higher hospital prices and spending. We found that an increase in contractual integration reduced the frequency of hospital admissions, but this effect was relatively small. Taken together, our results provide a mixed, although somewhat negative, picture of vertical integration from the perspective of the privately insured.