Devers Kelly J, Brewster Linda R, Casalino Lawrence P
Center for Studying Health System Change, Washington, DC 20024-2512, USA.
Health Serv Res. 2003 Feb;38(1 Pt 2):447-69. doi: 10.1111/1475-6773.00124.
To describe changes in hospitals' competitive strategies, specifically the relative emphasis placed on strategies for competing along price and nonprice (i.e., service, amenities, perceived quality) dimensions, and the reasons for any observed shifts.
This study uses data gathered through the Community Tracking Study site visits, a longitudinal study of a nationally representative sample of 12 U.S. communities. Research teams visited each of these communities every two years since 1996 and conducted between 50 to 90 semistructured interviews. Additional information on hospital competition and strategy was gathered from secondary data.
We found that hospitals' strategic emphasis changed significantly between 1996-1997 and 2000-2001. In the mid-1990s, hospitals primarily competed on price through "wholesale" strategies (i.e., providing services attractive to managed care plans). By 2000-2001, nonprice competition was becoming increasingly important and hospitals were reviving "retail" strategies (i.e., providing services attractive to individual physicians and the patients they serve). Three major factors explain this shift in hospital strategy: less than anticipated selective contracting and capitated payment; the freeing up of hospital resources previously devoted to horizontal and vertical integration strategies; and, the emergence and growth of new competitors.
Renewed emphasis on nonprice competition and retail strategies, and the service mimicking and one-upmanship that result, suggest that a new medical arms race is emerging. However, there are important differences between the medical arms race today and the one that occurred in the 1970s and early 1980s: the hospital market is more concentrated and price competition remains relatively important. The development of a new medical arms race has significant research and policy implications.
描述医院竞争策略的变化，特别是在价格和非价格（即服务、便利设施、感知质量）维度上竞争策略的相对重点，以及观察到的任何转变的原因。
本研究使用通过社区追踪研究实地考察收集的数据，这是一项对美国12个社区具有全国代表性样本的纵向研究。自1996年以来，研究团队每两年访问这些社区一次，并进行50至90次半结构化访谈。关于医院竞争和策略的其他信息从二手数据中收集。
我们发现，医院的战略重点在1996 - 1997年至2000 - 2001年期间发生了显著变化。在20世纪90年代中期，医院主要通过“批发”策略（即提供对管理式医疗计划有吸引力的服务）在价格上竞争。到2000 - 2001年，非价格竞争变得越来越重要，医院正在恢复“零售”策略（即提供对个体医生及其服务的患者有吸引力的服务）。有三个主要因素解释了医院策略的这种转变：选择性签约和按人头付费低于预期；以前用于横向和纵向整合策略的医院资源得到释放；以及新竞争对手的出现和增长。
对非价格竞争和零售策略的重新重视，以及由此产生的服务模仿和竞争升级，表明一场新的医疗军备竞赛正在出现。然而，今天的医疗军备竞赛与20世纪70年代和80年代初发生的军备竞赛存在重要差异：医院市场更加集中，价格竞争仍然相对重要。新医疗军备竞赛的发展具有重大的研究和政策意义。
