Langabeer James R, Ozcan Yasar A
Department of Management and Policy Sciences, The University of Texas School of Public Health, Houston, TX, USA.
Health Care Manag Sci. 2009 Jun;12(2):192-200. doi: 10.1007/s10729-008-9079-2.
Renewed debate over competition in healthcare suggests that greater specialization is good for the health economy. In essence, greater specialization is hypothesized to lead to lower average costs, due to learning curve effects, scale, or other operating efficiencies. This hypothesis was tested in oncology care, since this disease group is one of the few with existing specialized cancer centers already in place. Data envelopment analysis (DEA), and specifically a longitudinal Malmquist index over a 5-year period was applied to the major, specialized inpatient cancer centers to determine if these specialized centers achieve higher productivity over time, and if scale leads to higher operating efficiency. Results suggest policy and payer implications since these DRG-exempt hospitals may not be improving their technical efficiency over time. Despite advancements in technology and greater scale, the average efficiency of cancer care has marginally declined. Similarly, when compared to other hospitals with greater numbers of other service offerings, oncology care has not benefited from increasing returns to scale.
围绕医疗保健领域竞争的新一轮辩论表明，更高程度的专业化对医疗经济有益。从本质上讲，由于学习曲线效应、规模或其他运营效率，更高程度的专业化被假定会导致平均成本降低。这一假设在肿瘤护理领域进行了检验，因为该疾病组是少数几个已经设有专门癌症中心的领域之一。数据包络分析（DEA），特别是应用了一个为期5年的纵向Malmquist指数，对主要的专门住院癌症中心进行分析，以确定这些专门中心随着时间推移是否实现了更高的生产率，以及规模是否会带来更高的运营效率。结果表明了政策和支付方的影响，因为这些豁免诊断相关分组（DRG）的医院可能并没有随着时间推移提高其技术效率。尽管技术有所进步且规模更大，但癌症护理的平均效率略有下降。同样，与提供更多其他服务项目的其他医院相比，肿瘤护理并未从规模收益递增中受益。
