PHYSICIAN/HOSPITAL ORGANIZATION & MANAGED CARE CONTRACTS

医生/医院组织

• 批准号: 2718612
• 负责人: TIMOTHY S SNAIL
• 金额: $ 2.96万
• 依托单位: UNIVERSITY OF CALIFORNIA BERKELEY
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-08-01 至 1999-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2718612
• 关键词: behavioral /social science research tag; health care model; health care service evaluation; health economics; health services research tag; hospital analysis; hospital utilization; managed care; model design /development; physicians

Widespread expansion of managed care has caused dramatic evolution in the structure of the American health care delivery system, most notably in relationships between hospitals and physician organizations. Reducing health care cost growth without sacrificing quality requires increased coordination of care and better alignment of incentives between physicians and hospitals. Hospitals that fail to develop requisite health network infrastructure and managed care contracting skills will be disadvantaged in cost and quality competition and risk their very survival. Whether rapidly evolving forms of physician- hospital organizational arrangements (POAs) are capable of improving hospital performance is unclear. Federal and state regulators are concerned about implications of MSOs, PHOs, and other POAs for quality and cost, payment, insurance licensing, provider solvency, antitrust, and Medicare/Medicaid risk contracting. Proposed research consists of a conceptual and empirical analysis, through which I will investigate five research questions: (1) What are the salient aspects of incentive and control (selective contracting, payment mechanisms, utilization management) and physician/hospital ownership (vertical integration vs. contractual arrangements) of POAs? The research will develop a conceptual framework of POA strategy based on transaction cost economics and agency theory. Empirical analysis will investigate hospital and market structure drivers of (2) differences between POA strategy adopters and nonadopters, and (3) change in adoption patterns over time. Hospital performance in managed care contracting (HMO and PPO admission market shares) will be compared for (4) various POA strategies, and (5) POA strategy vs. market structure. Econometric models will control for hospital characteristics, market structure (hospital, physician, health plan), regulation, and self-selection bias. Research will use a unique federal/state dataset of 2,300 acute care hospitals nationwide in 1993 and 1996 and multistate subsample; panel data estimation of simultaneous equations will address serious methodological limitations of prior research.

管理型医疗保健的广泛扩展导致了 美国医疗保健提供系统的结构，最值得注意的是 在医院和医生组织之间的关系中。 在不牺牲质量的情况下降低医疗成本增长需要 加强护理协调和更好地协调激励措施 在医生和医院之间。没有发展起来的医院 必要的医疗网络基础设施和受管医疗合同 技能将在成本和质量竞争和风险中处于劣势 他们的生存之道。无论是快速演变的医生形式- 医院组织安排(POA)可以改进 医院的表现尚不清楚。联邦和州监管机构 关注MSO、PHO和其他POA对质量的影响 以及成本、支付、保险许可、供应商偿付能力、反垄断、 而联邦医疗保险/医疗补助计划有收缩的风险。拟议的研究包括 一个概念性和经验性的分析，我将通过它来调查 五个研究问题：(1)激励的显著方面是什么 和控制(选择性签约、支付机制、使用 管理)和医生/医院所有权(垂直整合与 合同安排)？这项研究将开发一种 基于交易成本经济学的POA战略概念框架 和代理理论。实证分析将调查医院和 市场结构驱动因素(2)POA战略差异 采用者和非采用者，以及(3)随着时间的推移，采用模式的变化。 医院在管理性医疗合同(HMO和PPO入院)中的表现 市场份额)将与(4)各种POA战略和(5)进行比较 POA战略与市场结构。计量经济模型将控制 医院特点、市场结构(医院、医生、卫生 计划)、监管和自我选择偏见。研究将使用一种独特的 1993年全国2300家急诊医院的联邦/州数据集 和1996年和多态子样本；面板数据估计的同时 方程式将解决之前的严重方法限制 研究。