Department of Health Service Research, Management, and Policy, University of Florida, USA.
Health Care Manage Rev. 2010 Oct-Dec;35(4):294-300. doi: 10.1097/HMR.0b013e3181e04a06.
Since the early 1990s, specialty hospitals have been continuously increasing in number. A moratorium was passed in 2003 that prohibited physicians' referrals of Medicare patients to newly established specialty hospitals if the physician has ownership stakes in the hospital. Although this moratorium expired in effect in 2007, many are still demanding that the government pass new policies to discourage the proliferation of specialty hospitals.
This study aimed at examining the regulatory and environmental forces that influence specialty hospitals founding rate. Specifically, we use the resource partitioning theory to investigate the relationship between general hospitals closure rates and the market entry of specialty hospitals. This study will help managers of general hospitals in their strategic thinking and planning.
We rely on secondary data resources, which include the American Hospital Association, Area Resource file, census, and Center for Medicare and Medicaid Services data, to perform a longitudinal analysis of the founding rate of specialty hospital in the 48 states. Specifically, we use the negative binomial generalized estimating equation approach available through Stata 9.0 to study the effect of general hospitals closure rate and environmental variables on the proliferation of specialty hospitals.
Specialty hospitals founding rate seems to be significantly related to general hospitals closure rates. Moreover, results indicate that economic, supply, regulatory, and financial conditions determine the founding rate of specialty hospitals in different states.
The results from this study indicate that the closure of general hospitals creates market conditions that encourage the market entry of specialized health care delivery forms such as specialty hospitals. Managers of surviving general hospitals have to view the closure of other general hospitals not just as an opportunity to increase market share but also as a threat of competition from new forms of health care organizations.
自 20 世纪 90 年代初以来，专科医院的数量不断增加。2003 年通过了一项暂停令，禁止医生将医疗保险患者转介到新成立的专科医院，如果医生在该医院拥有股份。尽管该暂停令实际上已于 2007 年到期，但许多人仍要求政府出台新政策，以阻止专科医院的泛滥。
本研究旨在考察影响专科医院成立率的监管和环境因素。具体来说，我们利用资源分割理论来研究综合医院关闭率与专科医院市场准入之间的关系。本研究将有助于综合医院的管理人员进行战略思考和规划。
我们依赖二次数据资源，包括美国医院协会、区域资源文件、普查和医疗保险和医疗补助服务中心的数据，对 48 个州的专科医院成立率进行纵向分析。具体来说，我们使用 Stata 9.0 中的负二项广义估计方程方法来研究综合医院关闭率和环境变量对专科医院扩散的影响。
专科医院成立率似乎与综合医院关闭率显著相关。此外，结果表明，经济、供应、监管和财务状况决定了不同州专科医院的成立率。
本研究结果表明，综合医院的关闭创造了市场条件，鼓励专门的医疗服务形式，如专科医院进入市场。幸存的综合医院的管理人员不仅要将其他综合医院的关闭视为增加市场份额的机会，还要将其视为来自新形式的医疗保健组织的竞争威胁。
