EFFECTS OF HORIZONTAL CONSOLIDATION OF HOSPITAL MARKETS

短期综合医院的经济环境发生了变化 戏剧性地。住院率在72%至79%之间， 1946年至1983年，但到1986年下降到64%，并一直保持在较低水平 尽管床位容量减少。医院的患者收入利润率 从1984年的1.5%下降到1987年以来的几乎为零。减少 在不耐烦的能力和竞争医院的数量可能会产生 节省资源有两个原因：减少空床的成本， 增加成本的非价格竞争，如积累 医院成本变动研究虽然过去对医院的研究 合并和系统收购通常没有发现净节省， 在横向合并中节省成本的激励措施现在更加强烈。 这个项目将分析1983年至1989年市场的变化 在300多个大都市地区集中医院护理， （a）对不耐烦的社区开支总额的增长的影响 护理，（B）医院收入利润，（c）无偿护理。不同 预计关闭、本地合并、系统收购和 新进入者。回归模型将控制输入的变化 价格、人口统计和支付服务的能力， 来自HMO和其他非医院门诊护理机构的竞争，以及 州政府和地方政府为医疗贫困者提供的费用。 第二个研究轨道将解决利用率和就业问题 地方合并后制度层面的变化 自1980年以来不涉及合并的收购。 这项研究可以为联邦的方法和政策做出贡献 关于医院的反垄断诉讼最近的法院案件没有被 能够利用对浓度随时间变化的影响的系统研究 变化此外，研究结果可能有助于关于以下问题的政策辩论： 目前减少资本成本偿还是否可取 更有选择性的策略，以识别容量利用率的变化 或为有意合并的企业提供补助赠款。最后，数据库将 应该是有用的，以广泛的研究， 卫生筹资和监管政策在社区一级的影响。

The economic environment of short-term general hospitals has changed dramatically. Inpatient occupancy rates ranged between 72% and 79% from 1946 to 1983, but fell to 64% by 1986 and have remained at that lower level despite reductions in bed capacity. Patient revenue margins for hospitals have fallen from about 1.5% in 1984 to nearly zero since 1987. Reductions in impatient capacity and the number of competing hospitals could yield resource savings for two reasons: reduced costs of empty beds, and reduced non-price competition that adds costs, as suggested by accumulating research on hospital cost variation. While past research on hospital mergers and system acquisitions has not typically found net savings, incentives for cost savings in horizontal consolidation are now stronger. This project will analyze changes from 1983 to 1989 in the market concentration of hospital care for over 300 metropolitan areas, and test for effects on (a) the growth of total community expenses for impatient care, (b) hospital revenue margins, and (c) uncompensated care. Different effects are expected from closures, local mergers, system acquisitions, and new entrants. The regression models will control for changes in input prices, population demographics and ability to pay for services, competition from HMOs and other non-hospital ambulatory care settings, and state and local government expenses for the medically indigent. A second track of research will address utilization rates and employment changes at the institution level after local mergers and system acquisitions not involving merger since 1980. This research could contribute to the methodologies and policies of federal antitrust actions regarding hospitals. Recent court cases have not been able to draw upon a systematic study of impacts over time of concentration changes. In addition, the findings could contribute to policy debates on whether the current reductions of capital cost reimbursement are preferable to more selective policies to recognize variations in capacity utilization or award grants for deliberate consolidations. Finally, the databases to be constructed should be useful to a broad range of research on community-level impacts of health financing and regulatory policies.