Siddharthan K, Ahern M, Rosenman R
Department of Health Policy and Management, University of South Florida, Tampa 33612, USA.
Health Care Manag Sci. 2000 Jan;3(1):23-9. doi: 10.1023/a:1019072819828.
We use Data Envelopment Analysis (DEA) to measure the relative technical efficiencies of 164 HMOs licensed to practice in the United States in 1995 with data collected from the American Association of Health Plans. Health care output measures used in the analysis are the number of commercial, Medicare and Medicaid lives covered in each plan. Inputs to the model are health care utilization measures such as the number of medical and surgical inpatient days, number of maternity and newborn stays in days, number of outpatient and emergency room visits and the number of non-invasive and invasive procedures performed on patients in an ambulatory setting. Mean efficiency of health plans was 40% (of the most efficient). We use multivariate analysis to try and explain variations in efficiency. Enrollment influences efficiency, with larger HMOs being more efficient than those with fewer enrollees. Plans with a more even distribution of Commercial, Medicare and Medicaid patients were more efficient on average than plans with heterogeneous mixes in enrollment. HMOs with Medicare patients are significantly less efficient, with efficiency decreasing with increasing Medicare participation in plan membership. Health plans in operation for longer periods of time had greater outputs with the same inputs. Health plans that had a majority of their enrollees in network or IPA type arrangements were more efficient as were for-profit plans compared to not-for-profits. Policy implications are discussed.
我们使用数据包络分析（DEA），根据从美国健康计划协会收集的数据，来衡量1995年在美国获得执业许可的164家健康维护组织（HMO）的相对技术效率。分析中使用的医疗保健产出指标是每个计划所涵盖的商业保险、医疗保险和医疗补助的参保人数。该模型的输入是医疗保健利用指标，如内科和外科住院天数、产科和新生儿住院天数、门诊和急诊就诊次数，以及在门诊环境中对患者进行的非侵入性和侵入性检查的次数。健康计划的平均效率为（最高效率的）40%。我们使用多变量分析来试图解释效率的差异。参保人数会影响效率，大型健康维护组织比参保人数较少的组织效率更高。商业保险、医疗保险和医疗补助患者分布更均匀的计划，平均而言比参保人群构成各异的计划效率更高。有医疗保险患者的健康维护组织效率明显较低，且随着医疗保险在计划成员中的参与度增加，效率会降低。运营时间较长的健康计划在投入相同的情况下产出更高。与非营利性计划相比，大多数参保人采用网络或独立执业协会（IPA）类型安排的健康计划以及营利性计划效率更高。文中还讨论了政策影响。
