HMO penetration, competition, and risk-adjusted hospital mortality.
HMO penetration, competition, and risk-adjusted hospital mortality.
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DOI：
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发表时间：
2001-12
影响因子：
3.4
通讯作者：
D. Mukamel;J. Zwanziger;K. Tomaszewski
中科院分区：
文献类型：
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作者：
D. Mukamel;J. Zwanziger;K. Tomaszewski
客观 HMO 已被证明对直接向其参与者提供的护理有影响。它们还可能通过溢出效应影响按服务收费计划向个人提供的护理。本研究的目的是调查 HMO 市场渗透率、HMO 和医院竞争以及通过风险调整后的医院死亡率衡量的 Medicare 按服务收费患者接受的护理质量之间的关联。数据来源 1990 年 134 个大都市统计区域（有 5 家或更多医院）的 1,927 家医院的数据包括来自 Medicare 医院信息报告的 Medicare 按服务收费风险调整死亡率、来自美国医院协会年度调查的医院特征以及根据 InterStudy 和美国团体健康协会数据计算的 HMO 市场渗透率和竞争。研究设计 统计回归技术用于确定 HMO 市场渗透率、竞争和风险调整死亡率之间的关联，并控制其他医院特征和地区。主要发现 更高的 HMO 市场渗透率和在较小程度上增加的 HMO 竞争与按服务付费医疗保险参保者更好的死亡率结果相关。医院之间的竞争没有表现出显着的关联。结论 HMO 可能会对参加按服务收费计划的个人所接受的护理质量产生溢出效应。这些发现可能是由于对当地实践风格的积极影响或 HMO 优先选择医院护理更好的地区来解释的。
OBJECTIVE HMOs have been shown to have an effect on the care provided directly to their enrollees. They may also influence the care provided to individuals in fee-for-service plans through a spill-over effect. The objective of this study was to investigate the associations among HMO market penetration, HMO and hospital competition, and the quality of care received by Medicare fee-for-service patients measured by risk-adjusted hospital mortality rates. DATA SOURCES The 1990 data for 1,927 hospitals in 134 metropolitan statistical areas (with five or more hospitals) included Medicare fee-for-service risk-adjusted mortality rates from the Medicare Hospital Information Reports, hospital characteristics from the American Hospital Association annual survey, and HMO market penetration and competition calculated from InterStudy and Group Health Association of America data. STUDY DESIGN Statistical regression techniques were used to identify the associations between HMO market penetration, competition, and risk-adjusted mortality, controlling for other hospital characteristics and region. PRINCIPAL FINDINGS Higher HMO market penetration and to a lesser degree increased HMO competition were associated with better mortality outcomes for fee-for-service Medicare enrollees. Competition between hospitals did not exhibit a significant association. CONCLUSIONS HMOs may have a spill-over effect on quality of care received by individuals enrolled in fee-for-service plans. These findings may be explained by a positive effect on local practice styles or a preferential selection by HMOs for areas with better hospital care.