接受优于给予？组织间服务安排与医院绩效。

Health Care Administration and Informatics, University of Wisconsin-Milwaukee, USA.

Health Care Manage Rev. 2010 Jan-Mar;35(1):88-97. doi: 10.1097/HMR.0b013e3181a93f8d.

BACKGROUND

The literature points to possible efficiencies in local-hospital-system performance, but little is known about the internal dynamics that might contribute to this. Study of the service arrangements that nearby same-system hospitals have with one another should provide clues into how system efficiencies might be attained.

PURPOSES

The purpose of this research was to better understand the financial and operational effects of service sharing and receiving arrangements among nearby hospitals belonging to the same systems.

METHODOLOGY/APPROACH: Data are compiled for the 1,227 U.S. urban acute care hospitals that belong to multihospital systems. A longitudinal structural equation model is employed-environmental pressures and organizational characteristics in 1997 are associated with service sharing and receiving arrangements in 2000; service sharing and receiving arrangements are then associated with performance in 2003. Service sharing and receiving are measured by counts of services focal hospitals report that are not duplicated by other-system hospitals within the same county. Linear Structural Relations (LISREL) is used to estimate the model.

FINDINGS

In general, market competition from managed care and hospitals influences hospitals to exchange services. For individual hospitals, service sharing has no effects on operational efficiency and financial performance. Service receiving, however, is related to greater efficiencies and higher profits.

PRACTICE IMPLICATIONS

The findings underscore the asymmetrical relationships that exist among local-system hospitals. Individual hospitals benefit from service receiving arrangements but not from sharing arrangements-it is better to receive than to give. To the extent that individual hospitals independently determine service capacities, systems may not be able to effectively rationalize service offerings.

背景

文献指出，在地方医院系统的运作中可能存在效率，但对于可能促成这一结果的内部动态却知之甚少。对附近同系统医院之间的服务安排进行研究，应该可以提供一些关于如何实现系统效率的线索。

目的

本研究旨在更好地了解属于同一系统的附近医院之间服务共享和接受安排的财务和运营影响。

方法/方法：为多医院系统所属的 1227 家美国城市急症护理医院编制数据。采用纵向结构方程模型——1997 年的环境压力和组织特征与 2000 年的服务共享和接受安排相关联；然后，服务共享和接受安排与 2003 年的绩效相关联。服务共享和接受是通过报告的服务数量来衡量的，这些服务是焦点医院在同一县内没有被其他系统医院复制的服务。线性结构关系（LISREL）用于估计模型。