Chan B, Feldman R, Manning W G
Health Research and Educational Trust, American Hospital Association, Chicago, IL 60606, USA.
Health Serv Res. 1999 Apr;34(1 Pt 1):9-31.
To determine factors that distinguish effective rural hospital consortia from ineffective ones in terms of their ability to improve members' financial performance. Two questions in particular were addressed: (1) Do large consortia have a greater collective impact on their members? (2) Does a consortium's economic environment determine the degree of collective impact on members?
Based on the hospital survey conducted during February 1992 by the Robert Wood Johnson Hospital-Based Rural Health Care project of rural hospital consortia. The survey data were augmented with data from Medicare Cost Reports (1985-1991), AHA Annual Surveys (1985-1991), and other secondary data.
Dependent variables were total operating profit, cost per adjusted admission, and revenue per adjusted admission. Control variables included degree of group formalization, degree of inequality of resources among members (group asymmetry), affiliation with other consortium group(s), individual economic environment, common hospital characteristics (bed size, ownership type, system affiliation, case mix, etc.), year (1985-1991), and census region dummies.
All dependent variables have a curvilinear association with group size. The optimum group size is somewhere in the neighborhood of 45. This reveals the benefits of collective action (i.e., scale economies and/or synergy effects) and the issue of complexity as group size increases. Across analyses, no strong evidence exists of group economic environment impacts, and the environmental influences come mainly from the local economy rather than from the group economy.
There may be some success stories of collaboration among hospitals in consortia, and consortium effects vary across different collaborations.
RELEVANCE/IMPACT: When studying consortia, it makes sense to develop a typology of groups based on some performance indicators. The results of this study imply that government, rural communities, and consortium staff and steering committees should forge the consortium concept by expanding membership in order to gain greater financial benefits for individual hospitals.
确定在改善成员财务绩效的能力方面，能区分有效农村医院联盟与无效联盟的因素。特别探讨了两个问题：（1）大型联盟对其成员是否有更大的集体影响？（2）联盟的经济环境是否决定对成员的集体影响程度？
基于1992年2月由罗伯特·伍德·约翰逊医院农村医疗保健项目对农村医院联盟进行的医院调查。调查数据通过医疗保险成本报告（1985 - 1991年）、美国医院协会年度调查（1985 - 1991年）及其他二手数据进行补充。
因变量为总运营利润、每调整后入院患者成本及每调整后入院患者收入。控制变量包括团体形式化程度、成员间资源不平等程度（团体不对称性）、与其他联盟团体的隶属关系、个体经济环境、共同的医院特征（床位规模、所有权类型、系统隶属关系、病例组合等）、年份（1985 - 1991年）以及人口普查区域虚拟变量。
所有因变量与团体规模呈曲线关联。最佳团体规模约为45左右。这揭示了集体行动的益处（即规模经济和/或协同效应）以及随着团体规模增加而产生的复杂性问题。在各项分析中，没有有力证据表明团体经济环境有影响，环境影响主要来自当地经济而非团体经济。
联盟中医院间的合作可能存在一些成功案例，且联盟效应在不同合作中有所不同。
相关性/影响：在研究联盟时，基于某些绩效指标制定团体类型学是有意义的。本研究结果意味着政府、农村社区、联盟工作人员及指导委员会应通过扩大成员来塑造联盟概念，以便为各医院获取更大的财务利益。
