The Effects of Single Specialty Hospital Entry on Hospital Market Competition

描述(由申请人提供)：提供心脏、整形外科和/或外科护理的单一专科医院(SSH)在美国医院中是一个相对较新且发展迅速的子行业。这些供应商大多由将患者转介给他们的医生所有，它们引发了相当大的争议，因为它们是支持不公平竞争还是提高经济效率，从而在成本和质量方面形成了一个新的具有竞争力的基准。然而，支持这些信念的科学知识基础尚未建立。本项目旨在通过分析SSH进入市场如何影响医院之间的竞争来解决这一不足。探讨社区医院竞争者在面对新的竞争挑战时的反应。更具体地说，它考察了SSH进入市场后竞争对手社区医院内与竞争过程的关键特征相关的变化：定价、质量、无偿护理、平均成本、利润率和服务组合。方法包括对三个SSH子行业在地理上集中且不断增长的关键州的州和国家级行政数据进行量化分析：德克萨斯州、加利福尼亚州和澳大利亚。该研究计划需要确定近年来在这三个州经历了医生拥有的SSH进入的医院市场。市场区域是达特茅斯卫生保健地图集中定义的医院转诊区域。分析计划是检查竞争对手医院行为和业绩在进入SSH前后的关键特征的变化，并将它们与位于没有医生拥有的SSH的市场的医院在同一时间段内的变化进行比较。这种差异法控制了趋势效应，因为对照组可能会受到与SSH进入市场的医院相同的时间影响。长期目标是评估与医生拥有的SSH进入当地市场相关的动态市场后果。了解SSH如何影响其运营市场的整体医院成本和质量，将为未来对以下问题的政策评估奠定基础：围绕单一专科组织医院护理是否真的增强了美国医院部门提供高质量价值驱动服务的能力？

DESCRIPTION (Provided by applicant): Single specialty hospitals (SSHs) that provide cardiac, orthopedic, and/or surgical care, are a relatively new and rapidly growing sub-industry among U.S. hospitals. These providers, the majority of which are owned by physicians who refer patients to them, have stirred considerable controversy over whether they support unfair competition or promote economic efficiency leading to a new competitive benchmark for costs and quality. Yet the scientific knowledge base supporting these convictions has not been established. This project aims to address this deficiency by analyzing how entry of SSHs into the marketplace affects competition among hospitals. It explores the responses of community hospital competitors in the face of the new competitive challenge. More specifically, it examines changes within competitor community hospitals following entry of SSHs into the marketplace that relate to key features of the competitive process: pricing, quality, uncompensated care, average costs, profit margins, and service mix. Methods comprise quantitative analysis of state and national level administrative data for three key states in which the SSH sub-industry is geographically concentrated and growing: TX, CA and AZ. The research plan entails identification of hospital markets that have experienced the entry of physician-owned SSHs in recent years in the three states. Market areas are Hospital Referral Regions as defined in the Dartmouth Atlas of Health Care. The analytic plan is to examine changes in the key features of competitor hospital behavior and performance before and after entry of the SSHs, and to compare them with changes over the same time period in hospitals located in markets where there are no physician-owned SSHs. This method, difference-in-differences, controls for trend effects because the comparison group is presumably subject to the same temporal influences as hospitals located in markets with SSH entry. The long-term objective is to assess the dynamic market consequences associated with entry of physician-owned SSHs into local markets. Knowledge of how SSHs affect overall hospital cost and quality in the markets where they operate will provide a foundation for future policy evaluation of the following question: Does the organization of hospital care around single specialties truly enhance the capability of the U.S. hospital sector in providing high-quality value-driven service?