ECONOMICS OF HOSPITAL CAPITAL EXPENDITURES

增加医院容量的决定是从以下方面解释的： 社会学，医学，战略，医生权力，寡头垄断理论，以及 其他各种观点。 效率和回报的财务因素- 投资并不重要。 然而，1991年10月之后， 资本成本将不再直接报销，这应该改变。 医院决策者对此的反应是一个重要的研究课题 问题. 到目前为止，资本成本尚未对Medicare Prospective做出反应 支付系统[PPS]的程度显示的运营成本。 然而， 将利息和折旧支付纳入单一病例级别DRG 速率隐含地假设容量决策将变得更加响应 在未来 这可能是不必要的。 本项目将提供对净资本影响的经验估计 财务结果的扩张和收缩，需求和效率， 制度特征、市场条件和支付参数。 回归将在所有美国医院的宇宙中运行， 医疗保险成本报告[MCR]在两年的基准期（1988-89）， 在医疗保险资本实际形成之前的一年预期期 1990年至1991年， （1992-1994年）。 一系列的案例将放大回归 关于资本决策的研究和广泛的问卷调查和访谈 从膨胀和收缩的分层随机样本中提取的过程 医院的 这些将被用来扩大基本的实证工作， 更丰富、更有用的行为模型。 关键的研究问题涉及[1]决策过程中可辨别的 1988- 1989年基期; [2] 固定资本支付; [3]医院具体效率，成本， 与过去和现在资本支出有关的强度和质量;以及 [4]如何进入资本市场，由于所有权，税收地位和 财政实力，限制或鼓励产能扩张， 巩固或收缩。

The decision to add hospital capacity has been explained in terms of sociology, medicine, strategy, physician power, oligopoly theory, and a variety of other perspectives. Financial factors of efficiency and return- on-investment have not been paramount. However, after October, 1991, when capital costs will no longer be directly reimbursed, this should change. The reaction of hospital decision-makers to this is an important research issue. So far capital costs have not responded to Medicare Prospective Payment System [PPS] to the degree shown by operating costs. Yet the plan to include payment for interest and depreciation in a flat case-level DRG rate implicitly assumes that capacity decisions will become more responsive in the future. This may not be warranted. This project will provide empirical estimates of the impact on net capital expansion and contraction of financial results, need & efficiency, institutional characteristics, market conditions, and payment parameters. Regressions will be run on the universe of all U.S. hospitals filing a Medicare Cost Report [MCR] over a two year base period (1988-89), a two year anticipation period before the actual shape of Medicare capital payment was known (1990-1991), and a three year initial implementation period (1992-1994). Amplifying the regressions will be a series of case studies and extensive questionnaires and interviews on the capital decision process taken from a stratified random sample of expanding and contracting hospitals. These will be used to expand the basic empirical work to a richer, more useful behavioral model. The key study questions concern [1] the decision process discernable in the 1988-89 base period; [2] the degree of change in investment behavior under fixed capital payment; [3] how hospital specific efficiency, cost, intensity, and quality relate to past and present capital expenditures; and [4] how access to the capital market due to ownership, tax status and financial strength, restrict or encourage capacity expansion, consolidation, or contraction.