Zwanziger Jack, Khan Nasreen
University of Illinois, Chicago, USA.
Med Care Res Rev. 2006 Dec;63(6 Suppl):90S-111S. doi: 10.1177/1077558706293838.
This article studies factors of safety-net hospitals that affect contracting with managed-care organizations. Web-based data were used to identify the hospital networks of managed-care plans in 71 metropolitan statistical areas. We collected lists of hospitals from a national sample of managed-care plans. After combining these data with hospital, managed-care, and area characteristics, multivariate logistic regressions with random effects were estimated to determine hospital characteristics that influence the probability of a contract between the plan and hospital. Hospital characteristics included size, ownership, whether it was part of a system, teaching status, and safety-net activities. Managed-care plan characteristics included type of plan and ownership. Certain safety-net hospital measures and a cluster of related hospital characteristics are associated with a lower probability of contract. Hospitals accounting for a disproportionate share of safety-net activities are less likely to belong to managed-care networks, which may place them at a competitive disadvantage.
本文研究了安全网医院中影响与管理式医疗组织签约的因素。利用基于网络的数据来识别71个大都市统计区的管理式医疗计划的医院网络。我们从管理式医疗计划的全国样本中收集了医院名单。在将这些数据与医院、管理式医疗及地区特征相结合后，估计了具有随机效应的多变量逻辑回归，以确定影响计划与医院之间签约概率的医院特征。医院特征包括规模、所有权、是否为系统的一部分、教学地位以及安全网活动。管理式医疗计划特征包括计划类型和所有权。某些安全网医院指标以及一系列相关的医院特征与较低的签约概率相关。承担不成比例的安全网活动份额的医院不太可能属于管理式医疗网络，这可能使它们处于竞争劣势。
