医院竞争、资源分配与医疗质量。
Hospital competition, resource allocation and quality of care.
作者信息
Mukamel Dana B, Zwanziger Jack, Bamezai Anil
机构信息
University of Rochester Medical Center, Rochester, New York 14642, USA.
出版信息
BMC Health Serv Res. 2002 May 27;2(1):10. doi: 10.1186/1472-6963-2-10.
BACKGROUND
A variety of approaches have been used to contain escalating hospital costs. One approach is intensifying price competition. The increase in price based competition, which changes the incentives hospitals face, coupled with the fact that consumers can more easily evaluate the quality of hotel services compared with the quality of clinical care, may lead hospitals to allocate more resources into hotel rather than clinical services.
METHODS
To test this hypothesis we studied hospitals in California in 1982 and 1989, comparing resource allocations prior to and following selective contracting, a period during which the focus of competition changed from quality to price. We estimated the relationship between clinical outcomes, measured as risk-adjusted-mortality rates, and resources.
RESULTS
In 1989, higher competition was associated with lower clinical expenditures levels compared with 1982. The trend was stronger for non-profit hospitals. Lower clinical resource use was associated with worse risk adjusted mortality outcomes.
CONCLUSIONS
This study raises concerns that cost reductions may be associated with increased mortality.
背景
人们采用了多种方法来控制不断攀升的医院成本。一种方法是加剧价格竞争。基于价格的竞争加剧改变了医院面临的激励机制，再加上与临床护理质量相比，消费者能够更轻松地评估酒店服务质量，这可能会导致医院将更多资源投入到酒店服务而非临床服务中。
方法
为了验证这一假设，我们研究了1982年和1989年加利福尼亚州的医院，比较了选择性合同签订前后的资源分配情况，在此期间竞争焦点从质量转向了价格。我们估计了以风险调整死亡率衡量的临床结果与资源之间的关系。
结果
与1982年相比，1989年竞争加剧与临床支出水平降低相关。这种趋势在非营利性医院中更为明显。临床资源使用减少与风险调整死亡率结果变差相关。
结论
本研究引发了人们对成本降低可能与死亡率上升相关的担忧。
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