Kim Sun Jung, Park Eun-Cheol, Yoo Ki-Bong, Kwon Jeoung A, Kim Tae Hyun
Department of Public Health, Yonsei University College of Medicine, Seoul, South Korea Institute of Health Services Research, Yonsei University College of Medicine, Seoul, South Korea.
Institute of Health Services Research, Yonsei University College of Medicine, Seoul, South Korea Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Asia Pac J Public Health. 2015 Mar;27(2):195-207. doi: 10.1177/1010539514529812. Epub 2014 Apr 14.
This study investigated the association of market competition with hospital charges, length of stay, and quality outcomes. A total of 279,847 patients from 851 hospitals were analyzed. The Herfindahl-Hirschman Index was used as a measure of hospital market competition level. Our results suggest that hospitals in less competitive markets charged more on charge per admission, possibly by increasing the length of stays, however, hospitals in more competitive markets charged more for daily services by providing more intensive services while reducing the length of stays, thereby reducing the overall charge per admission. Quality outcomes measured by mortality within 30 days of admission and readmission within 30 days of discharge were better for surgical procedures within competitive areas. Continued government monitoring of hospital response to market competition level is recommended in order to determine whether changes in hospitals' strategies influence the long-term outcomes of services performance and health care spending.
本研究调查了市场竞争与医院收费、住院时间及质量结果之间的关联。对来自851家医院的279847名患者进行了分析。赫芬达尔-赫希曼指数被用作衡量医院市场竞争水平的指标。我们的结果表明，竞争不太激烈市场中的医院每次住院收费更高，可能是通过延长住院时间来实现的；然而，竞争更激烈市场中的医院通过提供更密集的服务同时缩短住院时间，从而提高了每日服务收费，进而降低了每次住院的总体费用。对于竞争区域内的外科手术，以入院后30天内死亡率和出院后30天内再入院率衡量的质量结果更好。建议政府持续监测医院对市场竞争水平的反应，以确定医院策略的变化是否会影响服务绩效和医疗保健支出的长期结果。
