Kralewski J E, Countryman D D, Pitt L
Health Care Financ Rev. 1983 Summer;4(4):79-84.
With nearly a quarter of the population enrolled in Health Maintenance Organizations (HMOs) the Mineapolis/St. Paul metropolitan area provides a unique opportunity for studies dealing with the effects of prepaid health plans on the health care marketplace. This study explores one aspect of that market; discounts obtained by HMOs for hospital inpatient service. Using information gathered from structured interviews with the 7 HMOs and 30 hospitals in the Twin Cities area, the study addressed three areas of inquiry: (1) the nature of discount contracts between hospitals and HMOs, (2) the roles played by each party in initiating the contracts, and (3) factors influencing the establishment of the contracts. While each of the HMOs was found to have at least one hospital contract under which they received inpatient services for other than full-billed charges, the amount of the discount was not substantial in the majority of cases. Other factors such as hospital location and ability to provide a full range of services appear to be as important as financial discounts when HMOs select a hospital for inpatient services. It appears that hospitals played the lead role in initiating hospital/HMO contracts during the formative HMO years, but this initiative shifted to the HMOs as they gained market shares and bargaining power. Hospitals and HMOs agree that the most important factor influencing hospital willingness to consider discount contracts was and still is the surplus bed availability in the area. This surplus of beds has been exacerbated by a continued decline in hospital utilization. These conditions coupled with increased HMO market shares has recently resulted in intensified contract negotiations and further discounts for inpatient services.
明尼阿波利斯/圣保罗大都市地区有近四分之一的人口加入了健康维护组织（HMO），这为研究预付费健康计划对医疗市场的影响提供了独特的机会。本研究探讨了该市场的一个方面，即HMO获得的医院住院服务折扣。通过对双城地区7家HMO和30家医院进行结构化访谈收集信息，该研究涉及三个调查领域：（1）医院与HMO之间折扣合同的性质；（2）各方在启动合同中所起的作用；（3）影响合同签订的因素。虽然发现每家HMO至少有一份医院合同，根据该合同它们获得的住院服务费用并非全额计费，但在大多数情况下，折扣幅度并不大。当HMO选择医院提供住院服务时，医院位置和提供全方位服务的能力等其他因素似乎与财务折扣同样重要。在HMO发展初期，医院在启动医院/HMO合同方面似乎发挥了主导作用，但随着HMO获得市场份额和议价能力，这一主动权转移到了HMO手中。医院和HMO一致认为，影响医院考虑折扣合同意愿的最重要因素过去是、现在仍然是该地区的病床过剩情况。医院利用率的持续下降加剧了病床过剩的情况。这些情况加上HMO市场份额的增加，最近导致了合同谈判的加剧和住院服务的进一步折扣。
