Gift Thomas L, Arnould Richard, DeBrock Larry
Division of STD Prevention, Centers for Disease Control and Prevention, USA.
Inquiry. 2002 Spring;39(1):45-55. doi: 10.5034/inquiryjrnl_39.1.45.
Competition among hospitals is commonly regarded as inefficient due to the medical arms race phenomenon, but most evidence for this hypothesis predates the Medicare prospective payment system and preferred provider legislation. Recent studies indicate hospital competition reduces costs and prices, but nearly all such research has focused on California. We add to the body of literature that analyzes the effects of competition in hospital markets. Using data from the state of Washington, we show that hospitals assume more risk in competitive markets by being more likely to accept prospective payment arrangements with insurers. If the arrangement is retrospective, the hospital is more likely to offer a discount as the number of competing hospitals increases. Both findings indicate that competitive forces operate the same in hospital markets as in most others: as the number of competitors increases, prices decrease and market power shifts from the suppliers to purchasers. The medical arms race hypothesis that favors more concentrated hospital markets no longer appears to be valid.
由于医疗军备竞赛现象，医院之间的竞争通常被认为是低效的，但这一假设的大多数证据都早于医疗保险预期支付系统和首选供应商立法。最近的研究表明，医院竞争会降低成本和价格，但几乎所有此类研究都集中在加利福尼亚州。我们补充了分析医院市场竞争影响的文献。利用华盛顿州的数据，我们表明，医院在竞争激烈的市场中承担更多风险，因为它们更有可能接受与保险公司的预期支付安排。如果安排是追溯性的，随着竞争医院数量的增加，医院更有可能提供折扣。这两个发现都表明，竞争力量在医院市场中的运作方式与大多数其他市场相同：随着竞争对手数量的增加，价格下降，市场力量从供应商转移到购买者。支持医院市场更加集中的医疗军备竞赛假设似乎不再成立。
