Williams D, Hadley J, Pettengill J
Prospective Payment Assessment Commission, Washington, DC 20024.
Med Care. 1992 Feb;30(2):174-87. doi: 10.1097/00005650-199202000-00008.
The number of hospital closures increased substantially after the implementation of Medicare's Prospective Payment System (PPS). This acceleration in closures raised a number of concerns over current payment policies and their impact on access. This paper investigates hospital closures that occurred in 1985 through 1988. A hospital's financial status and mission or community standing were found to be determinants of hospital closure. Closed hospitals are much less likely to be publicly owned but more likely to offer fewer facilities and services, and have fewer cases. This may suggest that the patients directly affected by the closure can be absorbed by other hospitals or other nonhospital providers. Profitability is associated with the Medicare case-mix index and the share of Medicare patients. The findings also suggest that the case mix index may be rewarding some small hospitals in excess of the costs attributable to case-mix. For both urban and rural hospitals, a low share of Medicare patients increased the risk of hospital closure, independently of the relationship between Medicare share and profit. The share of Medicare patients also affected closure indirectly, through its effects on profit. Competition appears to affect the odds of closure through its effects on the number of cases. In addition, hospitals in areas with small or declining population are more at risk than other hospitals in both urban and rural areas.
医疗保险预期支付系统（PPS）实施后，医院关闭的数量大幅增加。关闭速度的加快引发了人们对当前支付政策及其对医疗可及性影响的诸多担忧。本文调查了1985年至1988年期间发生的医院关闭情况。研究发现，医院的财务状况、使命或社区地位是医院关闭的决定因素。关闭的医院公有制的可能性要小得多，但提供的设施和服务可能更少，病例也更少。这可能表明，受关闭直接影响的患者可以被其他医院或其他非医院医疗服务提供者接纳。盈利能力与医疗保险病例组合指数以及医疗保险患者的比例有关。研究结果还表明，病例组合指数对一些小医院的回报可能超过了因病例组合产生的成本。对于城市和农村医院来说，医疗保险患者比例较低会增加医院关闭的风险，这与医疗保险比例和利润之间的关系无关。医疗保险患者的比例还通过对利润的影响间接影响关闭情况。竞争似乎通过对病例数量的影响来影响关闭的几率。此外，在人口较少或人口减少地区的医院，无论在城市还是农村地区，比其他医院面临的风险都更大。
