Kirkman-Liff B L, Huijsman R, van der Grinten T, Brink G
College of Business, Arizona State University, Tempe 85287, USA.
Health Policy. 1997 Mar;39(3):207-23. doi: 10.1016/s0168-8510(96)00876-7.
A number of countries have adopted contracting reforms in which hospitals are placed at financial risk. This risk has stimulated a number of adaptive strategies to achieve organizational success. This paper presents a model of six forms of contracting relationships and reviews the adaptation strategies observed in three health systems: the USA, England and the Netherlands. These strategies include service diversification, improved management information systems, the employment of marketing and contract managers, the use of clinical pathways, case management and concurrent/retrospective review of hospital stays, quality management and quality assurance programs, pre-admission authorization, discharge planning, and physician profiling and participation in management. These adaptive strategies have three implications for managers: increased 'partnering', with purchasers, collaboration with medical staff, and assumption of managed care roles. Two groups of institutions are at risk from the changes in hospital contracting: university teaching hospitals and inner-city hospitals serving socially deprived populations. The paper ends with implications for the education of hospital managers and research on hospital management and adaptation to contracting.
许多国家都推行了合同承包制改革，使医院面临财务风险。这种风险促使医院采取了一系列适应性策略以实现组织的成功。本文提出了六种合同关系形式的模型，并审视了在美国、英国和荷兰这三个卫生系统中观察到的适应性策略。这些策略包括服务多样化、改进管理信息系统、聘用营销和合同管理人员、采用临床路径、病例管理以及对住院情况进行同期/回顾性审查、质量管理和质量保证计划、入院前授权、出院计划以及医生绩效评估和参与管理。这些适应性策略对管理人员有三点启示：加强与采购方的“合作”、与医务人员协作以及承担管理式医疗角色。有两类机构因医院合同承包制的变化而面临风险：大学教学医院和为社会贫困人群服务的市中心医院。本文最后探讨了对医院管理人员教育以及医院管理和合同承包制适应性研究的启示。
