The Effects of Single Specialty Hospital Entry on Hospital Market Competition

描述（由申请人提供）：提供心脏、骨科和/或外科护理的单一专科医院（SSHs）是美国医院中一个相对较新的、快速增长的子行业。这些提供医疗服务的机构，大部分是由转诊病人的医生所有，它们是否支持不公平竞争，还是促进经济效率，从而形成成本和质量的新竞争基准，引发了相当大的争议。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民营医院进入市场对医院间竞争的影响来解决这一不足。探讨社区医院竞争对手面对新的竞争挑战的应对之道。更具体地说，它考察了竞争对手社区医院在SSHs进入市场后的变化，这些变化与竞争过程的关键特征有关：价格、质量、无偿护理、平均成本、利润率和服务组合。方法包括对三个关键州的州和国家级行政数据进行定量分析，其中SSH子行业在地理上集中并不断增长：德克萨斯州，加利福尼亚州和亚利桑那州。研究计划需要确定近年来在三个州经历了医生拥有的SSHs进入的医院市场。市场区域是在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绩效的关键特征的变化，在进入SSHs之前和之后，并将其与位于没有医生拥有的SSHs的市场的医院在同一时期的变化进行比较。这种差异中的差异方法控制了趋势效应，因为比较组可能受到与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SSHs进入当地市场相关的动态市场后果。了解SSHs如何在其运营的市场中影响医院的整体成本和质量，将为以下问题的未来政策评估提供基础：围绕单一专业的医院护理组织是否真正提高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?