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、战略学、医生权力、寡头垄断理论和 各种不同的视角。效率和回报的财务因素- 持续投资并不是最重要的。然而，在1991年10月之后，当 资本成本将不再直接报销，这种情况应该会改变。 医院决策者对此的反应是一项重要的研究 问题。到目前为止，资本成本还没有对医疗保险的前景做出反应 支付系统[PPS]到运营成本所显示的程度。然而，这个计划 在平面案例级别的DRG中包括利息和折旧的支付 Rate隐含地假设容量决策将变得更具响应性 在未来。这可能是没有根据的。 该项目将提供对净资本影响的经验估计。 财务业绩、需求和效率的扩张和收缩， 机构特征、市场状况和支付参数。 回归将在所有美国医院提交的 两年基期(1988-89)的医疗保险成本报告[MCR]，两年 医疗保险资金实际形成前的年度预期期 已知付款(1990-1991年)，初步执行三年 期间(1992-1994年)。扩大回归将是一系列的案例 关于资本决策的研究和广泛的问卷调查和访谈 从扩展和收缩的分层随机样本获得的过程 医院。这些将被用于将基本的经验性工作扩展到 更丰富、更有用的行为模式。 关键的研究问题涉及[1]可辨别的决策过程 1988-1989年基期；[2]下列情况下投资行为的变化程度 固定资本支付；[3]医院的具体效率、成本、 与过去和现在的资本支出相关的强度和质量；以及 [4]如何因所有权、税收状况和 财政实力，限制或鼓励产能扩张， 合并，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.