Xirasagar Sudha, Lin Herng-Ching
Health Serv Res. 2004 Dec;39(6 Pt 2):2101-16. doi: 10.1111/j.1475-6773.2004.00334.x.
To test the hypotheses that: (1) average adjusted costs per discharge are higher in high-competition relative to low-competition markets, and (2) increased competition is associated with cost convergence between public and for-profit (FP) hospitals for case payment diagnoses, but not for cost-plus reimbursed diagnoses.
Taiwan's National Health Insurance database; 325,851 inpatient claims for cesarean section, vaginal delivery, prostatectomy, and thyroidectomy (all case payment), and bronchial asthma and cholelithiasis (both cost-based payment).
Retrospective population-based, cross-sectional study.
Diagnosis-wise regression analyses were done to explore associations between cost per discharge and hospital ownership under high and low competition, adjusted for clinical severity and institutional characteristics.
Adjusted costs per discharge are higher for all diagnoses in high-competition markets. For case payment diagnoses, the magnitudes of adjusted cost differences between public and FP hospitals are lower under high competition relative to low competition. This is not so for the cost-based diagnoses.
We find that the empirical evidence supports both our hypotheses.
检验以下假设：（1）与低竞争市场相比，高竞争市场中每次出院的平均调整成本更高；（2）竞争加剧与公立和营利性（FP）医院在病例支付诊断方面的成本趋同相关，但在成本加成报销诊断方面并非如此。
台湾国民健康保险数据库；325851例剖宫产、阴道分娩、前列腺切除术和甲状腺切除术（均为病例支付）以及支气管哮喘和胆石症（均为按成本支付）的住院索赔。
基于人群的回顾性横断面研究。
进行按诊断的回归分析，以探讨在高竞争和低竞争情况下，每次出院成本与医院所有权之间的关联，并对临床严重程度和机构特征进行调整。
高竞争市场中所有诊断的每次出院调整成本均较高。对于病例支付诊断，与低竞争相比，高竞争下公立和FP医院之间调整成本差异的幅度较小。基于成本的诊断则并非如此。
我们发现实证证据支持我们的两个假设。
