Department of Public Health, Catholic University of the Sacred Heart, Rome, Italy.
Health Care Manage Rev. 2013 Jul-Sep;38(3):234-47. doi: 10.1097/HMR.0b013e31824ccab8.
In the early 1990s, the governments of many countries took the first steps toward introducing market forces into the provision of health care services, with the aim of increasing hospital efficiency and quality of care. Several reforms have been developed to strengthen the role of competition, giving rise to forms of "managed competition." As a result, the environment in which providers operate and perform is increasingly characterized by conditions of competition, rather than of cooperation.
The aim of this study was to analyze the evolution of competitive interdependences among hospitals and the impact of organizational demographics on pair-wise competition.
Longitudinal data on competitive interdependences collected within a regional community of hospital organizations in the Italian National Health Service were analyzed. Stochastic actor-based models designed for estimating network dynamics were used to study organizational characteristics influencing patterns of change in competitive interdependences.
The results indicated that interorganizational cooperation is a significant predictor of competitive interdependences, that pair-wise competition among hospitals is primarily local, and that competitive interdependences are more likely to occur between local providers that differed with respect to performance and volume of activity.
Exploring the evolution of competitive interdependences between hospitals is salient for administrators who are interested in increasing their understanding of the whole market. They can better identify direct competitors by paying particular attention to those organizational characteristics that likely predict competitive actions. This approach is also important for policy makers, which may be interested in better targeting hospital restructuring interventions while implementing procompetition reforms.
20 世纪 90 年代初，许多国家的政府开始采取措施，将市场力量引入医疗服务提供领域，以提高医院的效率和护理质量。为此实施了多项改革，以加强竞争作用，形成了“管理式竞争”形式。因此，提供者运作和执行的环境越来越以竞争条件为特征，而不是合作条件。
本研究旨在分析医院之间竞争相互依存关系的演变，以及组织人口统计学特征对两两竞争的影响。
分析了意大利国家卫生服务体系中区域医院组织内收集的竞争相互依存关系的纵向数据。使用旨在估计网络动态的基于随机主体的模型来研究影响竞争相互依存关系变化模式的组织特征。
结果表明，组织间合作是竞争相互依存关系的重要预测因素，医院之间的两两竞争主要是局部的，竞争相互依存关系更有可能发生在绩效和活动量方面存在差异的本地提供者之间。
探索医院之间竞争相互依存关系的演变对那些有兴趣加深对整个市场理解的管理者很重要。他们可以通过特别关注那些可能预测竞争行为的组织特征，更好地识别直接竞争对手。这种方法对于政策制定者也很重要，他们可能有兴趣在实施支持竞争的改革时，更好地针对医院结构调整干预措施。
