Kesteloot K, Voet N
Center for Health Services and Nursing Research and Department of Applied Economics, K.U., Leuven, Belgium.
J Health Econ. 1998 Dec;17(6):701-28. doi: 10.1016/s0167-6296(98)00026-5.
Up to now, few analytical models have studied the incentives for cooperation in quality improvements among hospitals. Only those dealing with reimbursement systems have shown that, from the point of view of individual or competing hospitals, retrospective reimbursement is more likely to encourage quality improvements than prospective financing, while the reverse holds for efficiency improvements. This paper studies the incentives to improve the quality of hospital care, in an analytical model, taking into account the possibility of cooperative agreements, price besides non-price (quality) competition and quality improvements that may simultaneously increase demand, increase or reduce costs and spill over to rival hospitals. In this setting quality improvement efforts rise with the rate of prospective reimbursement, while the impact of the rate of retrospective reimbursement is ambiguous, but likely to be negative for quality improvements that are highly cost-reducting and create large spillovers. Cooperation may lead to more or less quality improvement than non-cooperative conduct, depending on the magnitude of spillovers and the degree of product market competition, relative to the net effect of quality on profits and the share of costs that is reimbursed retrospectively. Finally, the stability of cooperative agreements, supported by grim trigger strategies, is shown to depend upon exactly the opposite interaction between these factors.
到目前为止，很少有分析模型研究医院之间在质量改进方面的合作激励机制。只有那些涉及报销制度的研究表明，从单个医院或竞争医院的角度来看，回顾性报销比前瞻性融资更有可能鼓励质量改进，而在效率改进方面则相反。本文在一个分析模型中研究了提高医院护理质量的激励机制，考虑了合作协议的可能性、价格以及非价格（质量）竞争，以及质量改进可能同时增加需求、增加或降低成本并溢出到竞争对手医院的情况。在这种情况下，质量改进努力随着前瞻性报销率的提高而增加，而回顾性报销率的影响则不明确，但对于那些成本降低幅度大且产生大量溢出效应的质量改进来说，可能是负面的。合作可能比非合作行为带来或多或少的质量改进，这取决于溢出效应的大小、产品市场竞争的程度，相对于质量对利润的净影响以及回顾性报销的成本份额。最后，由冷酷触发策略支持的合作协议的稳定性表明，它恰恰取决于这些因素之间相反的相互作用。
