Catholic University of the Sacred Heart, Department of Public Health, Largo F. Vito 1, 00168 Rome, Italy.
Health Policy. 2012 May;105(2-3):273-81. doi: 10.1016/j.healthpol.2012.02.011. Epub 2012 Mar 10.
Policymakers stimulate competition in universalistic health-care systems while encouraging the formation of service provision networks among hospital organizations. This article addresses a gap in the extant literature by empirically analyzing simultaneous collaboration and competition between hospitals within the Italian National Health Service, where important procompetition reforms have been implemented.
To explore how rising competition between hospitals relates to their propensity to collaborate with other local providers.
Longitudinal data on interhospital collaboration and competition collected in an Italian region from 2003 to 2007 are analyzed. Social network analysis techniques are applied to study the structure and dynamics of interhospital collaboration. Negative binomial regressions are employed to explore how interhospital competition relates to the collaborative network over time.
Competition among providers does not hinder interhospital collaboration. Collaboration is primarily local, with resource complementarity and differentials in the volume of activity and hospital performance explaining the propensity to collaborate.
Formation of collaborative networks among hospitals is not hampered by reforms aimed at fostering market forces. Because procompetition reforms elicit peculiar forms of managed competition in universalistic health systems, studies are needed to clarify whether the positive association between interhospital competition and collaboration can be generalized to other health-care settings.
政策制定者在鼓励医疗机构形成服务提供网络的同时，也在促进普及性医疗保健系统中的竞争。本文通过实证分析意大利国家卫生服务体系内医院之间的合作和竞争，填补了现有文献的空白，意大利在该体系中实施了重要的促进竞争改革。
探究医院之间竞争的加剧如何影响它们与其他本地医疗机构合作的倾向。
利用意大利一个地区 2003 年至 2007 年期间收集的医院间合作和竞争的纵向数据，运用社会网络分析技术研究医院间合作的结构和动态。采用负二项回归模型，探究医院间竞争与合作网络随时间的变化关系。
提供者之间的竞争并没有阻碍医院间的合作。合作主要是本地化的，资源互补性以及活动量和医院绩效的差异解释了合作的倾向。
旨在促进市场力量的改革并没有阻碍医院间合作网络的形成。由于促进竞争的改革在普及性医疗保健系统中引发了特殊形式的管理竞争，因此需要进行研究以明确医院间竞争与合作之间的正相关关系是否可以推广到其他医疗保健环境。
