CHANGING MARKETS AND HOSPITALS

医院市场正在迅速变化；在医院与其他医院和医生团体联合起来的同时，管理式护理的普及率也在不断提高。本研究使用结构模型来探讨医院市场的三种趋势的影响，包括管理式医疗的扩展、横向整合和医院与医生之间的垂直结盟。该研究解决了三个关键问题：在多大程度上，日益增长的管理式医疗影响了住院医院服务需求的价格和质量弹性？形成网络和系统的医院能比没有形成网络和系统的医院维持更高的价格吗？最后，与医生签订合同的医院是否比其他医院拥有更大的市场力量？这些问题对联邦和州监管机构（包括公共采购机构和反垄断机构）至关重要，他们评估医院的横向和纵向战略对医院服务提供的潜在效率、获取、反竞争和质量影响。例如，医疗保险最近推动了提供者赞助组织的形成，这些组织将医院和医生服务结合起来。医疗保险和医疗补助的政策制定者都有必要了解新的组织形式和采购系统的潜在影响。本研究同时探讨管理式医疗与医院整合策略的需求与供给效应，对现有研究有贡献。与大多数现有的关于这些主题的简化形式的研究相比，结构模型特别适合于模拟市场变化。

Hospital markets are rapidly changing; managed care penetration is increasing at the same time that hospitals are joining forces with other hospitals and with physician groups. This research project uses a structural model to investigate the impact of three trends in hospital markets, including the expansion of managed care, horizontal integration, and vertical alignment between hospitals and physicians. The study addresses three key questions: To what extent has growing managed care affected the price and quality elasticity of demand for inpatient hospital services? Can hospitals that form networks and systems maintain higher prices than hospitals that do not? And, finally, do hospitals that form contracting arrangements with physicians have greater market power than other hospitals? These issues are of primary important to federal and state regulators, including public purchasers and antitrust authorities, who evaluate the potential efficiency, access, anticompetitive, and quality impacts of hospital's horizontal and vertical strategies on delivery of hospital services. Medicare, for example, has recently promoted the formation of Provider- Sponsored Organizations, which integrate hospital and physician services. Medicare and Medicaid policymakers alike have a stake in understanding the potential impact of new organizational forms and procurement systems. This study contributes to the existing research by simultaneously investigating both demand and supply effects of managed care and hospital integration strategies. A structural model, compared to most of the existing reduced-form studies on these topics, is particularly suited for simulations of market changes.