Gozvrisankaran Gautam, Town Robert J
Health Serv Res. 2003 Dec;38(6 Pt 1):1403-21. doi: 10.1111/j.1475-6773.2003.00185.x.
To estimate the effects of competition for both Medicare and HMO patients on the quality decisions of hospitals in Southern California.
Secondary discharge data from the Office of Statewide Health Planning and Development for the State of California for the period 1989-1993.
Outcome variables are the risk-adjusted hospital mortality rates for pneumonia (estimated by the authors) and acute myocardial infarction (AMI) (reported by the state of California). Measures of competition are constructed for each hospital and payer type. The competition measures are formulated to mitigate the possibility of endogeneity bias. The relationships between risk-adjusted mortality and the different competition measures are estimated using ordinary least squares.
The study finds that an increase in the degree of competition for health maintenance organization (HMO) patients is associated with a decrease in risk-adjusted hospital mortality rates. Conversely, an increase in competition for Medicare enrollees is associated with an increase in risk-adjusted mortality rates for hospitals.
In conjunction with previous research, the estimates indicate that increasing competition for HMO patients appears to reduce prices and save lives and hence appears to improve welfare. However, increases in competition for Medicare appear to reduce quality and may reduce welfare. Increasing competition has little net effect on hospital quality in our sample.
评估医疗保险和健康维护组织（HMO）患者竞争对南加州医院质量决策的影响。
加利福尼亚州全州卫生规划与发展办公室提供的1989 - 1993年期间的二次出院数据。
结果变量为肺炎（由作者估算）和急性心肌梗死（AMI）（由加利福尼亚州报告）的风险调整后医院死亡率。针对每家医院和支付方类型构建竞争指标。竞争指标的制定旨在减轻内生性偏差的可能性。使用普通最小二乘法估计风险调整后死亡率与不同竞争指标之间的关系。
研究发现，健康维护组织（HMO）患者竞争程度的增加与风险调整后医院死亡率的降低相关。相反，医疗保险参保者竞争的增加与医院风险调整后死亡率的增加相关。
结合先前的研究，这些估计表明，健康维护组织（HMO）患者竞争的增加似乎会降低价格并挽救生命，因此似乎会改善福利。然而，医疗保险竞争的增加似乎会降低质量并可能减少福利。在我们的样本中，竞争增加对医院质量的净影响很小。
