O'Malley Ann S, Bond Amelia M, Berenson Robert A
Issue Brief Cent Stud Health Syst Change. 2011 Aug(136):1-4.
In a quest to gain market share, hospital employment of physicians has accelerated in recent years to shore up referral bases and capture admissions, according to the Center for Studying Health System Change's (HSC) 2010 site visits to 12 nationally representative metropolitan communities. Stagnant reimbursement rates, coupled with the rising costs of private practice, and a desire for a better work-life balance have contributed to physician interest in hospital employment. While greater physician alignment with hospitals may improve quality through better clinical integration and care coordination, hospital employment of physicians does not guarantee clinical integration. The trend of hospital-employed physicians also may increase costs through higher hospital and physician commercial insurance payment rates and hospital pressure on employed physicians to order more expensive care. To date, hospitals' primary motivation for employing physicians has been to gain market share, typically through lucrative service-line strategies encouraged by a fee-for-service payment system that rewards volume. More recently, hospitals view physician employment as a way to prepare for payment reforms that shift from fee for service to methods that make providers more accountable for the cost and quality of patient care.
根据医疗体系变革研究中心（HSC）2010年对12个具有全国代表性的大都市社区进行的实地考察，为了获取市场份额，近年来医院对医生的聘用加速，以巩固转诊基础并争取住院量。报销费率停滞不前，加上私人执业成本不断上升，以及对更好的工作与生活平衡的渴望，促使医生对受雇于医院产生兴趣。虽然医生与医院的联系更加紧密可能会通过更好的临床整合和护理协调来提高质量，但医院聘用医生并不能保证临床整合。医院聘用医生的趋势还可能通过提高医院和医生商业保险支付率以及医院向受雇医生施压要求其安排更昂贵的治疗而增加成本。迄今为止，医院聘用医生的主要动机一直是获取市场份额，通常是通过按服务收费支付系统鼓励的利润丰厚的服务线策略来实现，这种系统奖励工作量。最近，医院将聘用医生视为一种为支付改革做准备的方式，支付改革正从按服务收费转向使医疗服务提供者对患者护理的成本和质量更负责的方式。
