Brooks J M, Dor A, Wong H S
University of Iowa, College of Pharmacy, Iowa City 55242, USA.
J Health Econ. 1997 Aug;16(4):417-34. doi: 10.1016/s0167-6296(96)00536-x.
Employers' increased sensitivity to health care costs has forced insurers to seek ways to lower costs through effective bargaining with providers. What factors determine the prices negotiated between hospitals and insurers? The hospital-insurer interaction is captured in the context of a bargaining model, in which the gains from bargaining are explicitly defined. Appendectomy was chosen because it is a well-defined procedure with little clinical variation. Our results show that certain hospital institutional arrangements (e.g. hospital affiliations), HMO penetration, and greater hospital concentration improve hospitals' bargaining position. Furthermore, hospitals' bargaining effectiveness has diminished over time and varies across states.
雇主对医疗保健成本的敏感度增加，迫使保险公司寻求通过与医疗服务提供者进行有效谈判来降低成本的方法。哪些因素决定了医院和保险公司之间协商的价格？医院与保险公司的互动在一个谈判模型的背景下进行描述，其中谈判收益被明确界定。选择阑尾切除术是因为它是一个定义明确、临床差异小的手术。我们的结果表明，某些医院制度安排（如医院附属关系）、健康维护组织（HMO）的渗透率以及更高的医院集中度会改善医院的谈判地位。此外，医院的谈判效果随着时间的推移而减弱，并且在不同州有所不同。
