Forgione D A
Merrick School of Business, University of Baltimore, MD, USA.
J Health Care Finance. 1999 Summer;25(4):38-46.
With the ever-increasing market penetration of capitated payment systems throughout health care markets, average payment rates for health services have dropped correspondingly. At the same time, the added competitive pressures from managed care organizations have served to increase the demand for new capital investment in information systems, lower cost facilities, and innovative modes for delivering all types of health care services. As a result, many nonprofit health care organizations have converted, or have attempted to convert, to for-profit status in an effort to gain access to the public equity capital markets. As hospitals, Blue Cross and Blue Shield organizations, and other nonprofit health care organizations across the U.S. seek to convert to for-profit status, they are finding the path is not easy. Access to capital, operating efficiencies, and the need to accelerate movement into new markets are offset by public benefit obligations, potential private inurement, and significant political cost issues. The bottom line is whether the conversion will be structured to both protect the public interest and allow the health care organization the flexibility and access to capital it needs in order to continue as a viable, competitive organization into the next millennium.
随着按人头付费系统在整个医疗保健市场的市场渗透率不断提高，医疗服务的平均支付率相应下降。与此同时，管理式医疗组织带来的额外竞争压力促使对信息系统、低成本设施以及提供各类医疗服务的创新模式的新资本投资需求增加。结果，许多非营利性医疗保健组织已经或试图转变为营利性组织，以努力进入公共股权资本市场。在美国，随着医院、蓝十字蓝盾组织以及其他非营利性医疗保健组织寻求转变为营利性组织，他们发现这条路并不容易。获得资本、运营效率以及加速进入新市场的需求，被公共利益义务、潜在的私人获利以及重大的政治成本问题所抵消。关键在于，这种转变的结构是否既能保护公共利益，又能让医疗保健组织具备灵活性并获得所需资本，以便在进入下一个千年之际继续作为一个可行且有竞争力的组织存在。
