Wang B B, Wan T T, Clement J, Begun J
National Defence Medical Center, Taipei, Taiwan.
Health Care Manag Sci. 2001 Sep;4(3):181-91. doi: 10.1023/a:1011492731396.
The purpose of this study is to examine the association of managed care with hospital vertical integration strategies, as well as to observe the relationships of different types of vertical integration with hospital efficiency and financial performance.
The sample consists of 363 California short-term acute care hospitals in 1994. Linear structure equation modeling is used to test six hypotheses derived from the strategic adaptation model. Several organizational and market factors are controlled statistically.
Results suggest that managed care is a driving force for hospital vertical integration. In terms of performance, hospitals that are integrated with physician groups and provide outpatient services (backward integration) have better operating margins, returns on assets, and net cash flows (p < 0.01). These hospitals are not, however, likely to show greater productivity. Forward integration with a long-term-care facility, on the other hand, is positively and significantly related to hospital productivity (p < 0.001). Forward integration is negatively related to financial performance (p < 0.05), however, opposite to the direction hypothesized.
Health executives should be responsive to the growth of managed care in their local market and should probably consider providing more backward integrated services rather than forward integrated services in order to improve the hospital's financial performance in today's competitive health care market.
本研究旨在探讨管理式医疗与医院垂直整合策略之间的关联，同时观察不同类型的垂直整合与医院效率及财务绩效之间的关系。
样本包括1994年加利福尼亚州的363家短期急症护理医院。采用线性结构方程模型来检验从战略适应模型得出的六个假设。对若干组织和市场因素进行了统计控制。
结果表明，管理式医疗是医院垂直整合的驱动力。在绩效方面，与医生团体整合并提供门诊服务的医院（向后整合）具有更好的营业利润率、资产回报率和净现金流（p < 0.01）。然而，这些医院的生产率可能不会更高。另一方面，与长期护理机构的向前整合与医院生产率呈正相关且具有显著意义（p < 0.001）。不过，向前整合与财务绩效呈负相关（p < 0.05），与假设的方向相反。
医疗行业高管应顺应本地市场管理式医疗的发展趋势，为提升医院在当今竞争激烈的医疗市场中的财务绩效，或许应考虑提供更多向后整合服务而非向前整合服务。
