Morrisey M A, Conrad D A, Shortell S M, Cook K S
J Health Econ. 1984 Apr;3(1):25-47. doi: 10.1016/0167-6296(84)90024-9.
This paper presents a theory of the effects of rate review on hospital operations and organization. Its purpose is to explain the way in which hospitals have responded to regulation. In the development of this theory, the hospital product was viewed as a bundle of services, rate review was looked upon as a ceiling on the value of the bundle. The ceiling creates an incentive to remove elements from the bundle, i.e., to reduce 'quality'. When quality is variable, the effect on utilization becomes indeterminate. The model argues, among other things, that the hospital will change its service complement and its contractural arrangements with physicians and other hospitals. An extension of the organizational theory literature leads to implications concerning the ordering of hospital responses to regulation. The growing body of empirical literature on the effects of hospital rate review is used as an initial test of the major thrusts of the theory. A suggested agenda for further empirical work also is presented.
本文提出了一种关于费率审查对医院运营和组织影响的理论。其目的是解释医院对监管的应对方式。在该理论的发展过程中，医院产品被视为一系列服务的组合，费率审查被视为该服务组合价值的上限。这个上限产生了从服务组合中去除某些要素的动机，即降低“质量”。当质量可变时，对利用率的影响就变得不确定。该模型认为，医院将改变其服务组合以及与医生和其他医院的合同安排。组织理论文献的扩展产生了有关医院对监管反应顺序的影响。关于医院费率审查影响的实证文献不断增加，被用作对该理论主要观点的初步检验。本文还提出了进一步实证研究工作的建议议程。
