Morrisey M A, Alexander J, Burns L R, Johnson V
University of Alabama at Birmingham, Lister Hill Center for Health Policy, 35294-0022, USA.
Med Care. 1999 Apr;37(4):350-61. doi: 10.1097/00005650-199904000-00005.
To empirically estimate the effects that managed care has had on physician and clinical integration in urban hospitals.
The 1993 Hospital-Physician Relationship Survey conducted for the Prospective Payment Assessment Commission, augmented with data from a variety of secondary sources. The entire 1,495 responding hospitals were used to construct measures of integration; 591 responding hospitals in urban areas were used for the managed care analysis.
Factor analysis was used to reduce 23 integration variables into 5 physician and 3 clinical integration factors. Two-stage least-squares regression techniques were used to estimate the effects of endogenous managed care. Models were estimated for all urban hospitals and for hospital subsets based upon ownership, multi-hospital system status, and teaching.
Other things equal, physician involvement in hospital management and governance increased with managed care involvement; to a lesser degree, the use of physician organization arrangements and other joint ventures also increased. Practice management and support services were lower in hospitals with high managed care activity. Larger hospitals, investor owned, system, and non-teaching hospitals had larger managed care revenues. Managed care revenues were lower in more concentrated hospital markets.
The relationship between managed care and physician and clinical integration is relatively modest. Much of the realignment under managed care has been limited to certain types of efforts. Those efforts can best be described as foundation-building rather than comprehensive or fundamental.
实证评估管理式医疗对城市医院中医生与临床整合的影响。
为预期支付评估委员会开展的1993年医院-医生关系调查，并补充了各种二手来源的数据。全部1495家回应医院用于构建整合指标；591家城市地区的回应医院用于管理式医疗分析。
采用因子分析将23个整合变量缩减为5个医生整合因子和3个临床整合因子。运用两阶段最小二乘法回归技术来估计内生性管理式医疗的影响。针对所有城市医院以及基于所有权、多医院系统状况和教学情况划分的医院子集估计模型。
在其他条件相同的情况下，医生参与医院管理和治理的程度随着管理式医疗参与度的提高而增加；在较小程度上，医生组织安排和其他合资企业的使用也有所增加。管理式医疗活动频繁的医院中，实践管理和支持服务水平较低。规模较大的医院、投资者所有的医院、系统医院和非教学医院的管理式医疗收入较高。在医院市场集中度较高的地区，管理式医疗收入较低。
管理式医疗与医生及临床整合之间的关系相对有限。管理式医疗下的许多调整仅限于某些类型的努力。这些努力最好被描述为打基础，而非全面或根本性的变革。
