PHYSICIAN/HOSPITAL ORGANIZATION & MANAGED CARE CONTRACTS

管理式医疗的广泛扩展导致了 美国医疗保健提供系统的结构， 医院和医生组织之间的关系。 在不牺牲质量的情况下降低医疗保健成本增长需要 加强护理协调，更好地调整激励措施 在医生和医院之间。 发展失败的医院 必要的保健网络基础设施和管理式保健合同 技能将在成本和质量竞争中处于不利地位， 他们的生存。 无论是快速发展的医生- 医院组织安排（POA）能够改善 医院的业绩不明朗。 联邦和州监管机构 关注MSO、PHO和其他POA对质量的影响 和成本，支付，保险许可，供应商偿付能力，反垄断， 和医疗保险/医疗补助风险合同。 拟议的研究包括 一个概念和实证分析，通过它我将调查 五个研究问题：（1）激励的突出方面是什么？ 和控制（选择性承包、支付机制、使用 管理）和医生/医院所有权（垂直整合与 （一）合同约定？ 该研究将开发一种 基于交易成本经济学的POA战略概念框架 代理理论。 实证分析将调查医院和 市场结构驱动因素（2）POA策略之间的差异 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。 医院在管理式医疗合同中的绩效（HMO和PPO入院 市场份额）将比较（4）各种POA策略，以及（5） POA战略与市场结构。 经济计量模型将控制 医院特点，市场结构（医院，医生，健康 计划）、监管和自我选择偏差。 研究将使用一种独特的 联邦/州1993年全国2,300家急症护理医院数据集 和1996年和多状态子样本;面板数据估计的同时 方程将解决严重的方法局限性， research.

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.