Impact of Specialty Hospitals on Procedure Utilization

描述：专科医院，提供仅限于特定条件或程序的护理，正在美国各地迅速开放。在人们对专科医院数量增加的担忧中，最主要的是它们对地方综合性医院的潜在有害影响。专科医院往往专注于最有利可图的服务，如心血管和骨科手术。由于它们抽走了最“有利可图”的服务，许多人担心与之竞争的综合医院的财务生存能力，以及它们最终提供急诊等无利可图但必不可少的服务的能力。第二个问题是，专科医院的增长可能会增加卫生保健服务的总体利用率。由于专科医院通常部分归在那里工作的医生所有，特别强大的经济激励可能进一步推动“供应商诱导”的需求和选定手术的使用。虽然这两种担忧都有表面的有效性，但都没有经过实证检验。基于这些原因，我们建议研究两个相关问题：1)专科医院的开业对竞争性综合医院的手术量有何影响？专科医院如何影响整个人群对手术的总体利用？我们将使用国家医疗保险数据（1994-2002年）来确定专科医院和在同一医院转诊区域（HRRs）提供类似服务的综合医院。我们的具体目标1将重点关注4种手术（冠状动脉旁路移植术、经皮冠状动脉介入治疗、全髋关节置换术和全膝关节置换术），首先检查综合医院在引入专科医院之前和之后的手术量。然后，我们的具体目标2将评估专科医院在人力资源管理水平上对基于人群的四种手术率的影响。我们的研究结果将有助于政策制定者更好地理解专科医院与程序利用之间的关系，特别是在国会努力解决是否将最近暂停新专科医院建设的问题。

DESCRIPTION: Specialty hospitals, which provide care limited to specific conditions or procedures, are opening at a rapid pace across the United States. Chief among the concerns about the rise in specialty hospitals is their potential deleterious effect on local, full-service general hospitals. Specialty hospitals tend to focus on the most lucrative services such as cardiovascular and orthopedic procedures. As they siphon away the most "profitable" services, many worry about the financial viability of competing general hospitals and ultimately their ability to provide unprofitable but essential services such as emergency care. A second concern is that the growth of specialty hospitals could increase overall utilization of health care services. Because specialty hospitals are usually owned in part by the physicians who work there, particularly strong financial incentives could further fuel "supplier-induced" demand and the use of selected procedures. Although both concerns have face validity, neither has been examined empirically. For these reasons, we propose to study two related issues: 1) What impact does a specialty hospital's opening have on procedural volumes at competing general hospitals?; and 2) How do specialty hospitals effect overall utilization of procedures across a population? We will use of national Medicare data (1994-2002) to identify specialty hospitals and those general hospitals providing similar services in the same hospital referral regions (HRRs). Focusing on 4 procedures (coronary artery bypass grafting, percutaneous coronary intervention, total hip arthroplasty, and total knee arthroplasty), our Specific Aim 1 will first examine procedural volumes at general hospitals before and after the introduction of specialty hospitals. Our Specific Aim 2 will then assess the impact of specialty hospitals on population-based rates for the four procedures at the HRR-level. Our findings will help policy-makers better understand the relationship between specialty hospitals and procedural utilization, especially as Congress struggles with the question of whether to make a recent moratorium on new specialty hospital construction permanent.