Dong Gang Nathan
Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 600 W 168th Street, 10032, New York, NY, USA.
BMC Health Serv Res. 2015 Feb 1;15:45. doi: 10.1186/s12913-015-0690-x.
Fiscal constraints faced by U.S. hospitals as a result of the recent economic downturn are leading to business practices that reduce costs and improve financial and operational efficiency in hospitals. There naturally arises the question of how this finance-driven management culture could affect the quality of care. This paper attempts to determine whether the process measures of treatment quality are correlated with hospital financial performance.
Panel study of hospital care quality and financial condition between 2005 and 2010 for cardiovascular disease treatment at acute care hospitals in the United States. Process measures for condition-specific treatment of heart attack and heart failure and hospital-level financial condition ratios were collected from the CMS databases of Hospital Compare and Cost Reports.
There is a statistically significant relationship between hospital financial performance and quality of care. Hospital profitability, financial leverage, asset liquidity, operating efficiency, and costs appear to be important factors of health care quality. In general, public hospitals provide lower quality care than their nonprofit counterparts, and urban hospitals report better quality score than those located in rural areas. Specifically, the first-difference regression results indicate that the quality of treatment for cardiovascular patients rises in the year following an increase in hospital profitability, financial leverage, and labor costs.
The results suggest that, when a hospital made more profit, had the capacity to finance investment using debt, paid higher wages presumably to attract more skilled nurses, its quality of care would generally improve. While the pursuit of profit induces hospitals to enhance both quantity and quality of services they offer, the lack of financial strength may result in a lower standard of health care services, implying the importance of monitoring the quality of care among those hospitals with poor financial health.
近期经济衰退给美国医院带来的财政压力正促使医院采取降低成本、提高财务和运营效率的商业做法。自然而然地就出现了这样一个问题：这种由财务驱动的管理文化会如何影响医疗质量。本文试图确定治疗质量的过程指标是否与医院财务绩效相关。
对2005年至2010年美国急症医院心血管疾病治疗的医院护理质量和财务状况进行面板研究。从医院比较和成本报告的医疗保险和医疗补助服务中心（CMS）数据库中收集针对心脏病发作和心力衰竭的特定病情治疗的过程指标以及医院层面的财务状况比率。
医院财务绩效与医疗质量之间存在统计学上的显著关系。医院盈利能力、财务杠杆、资产流动性、运营效率和成本似乎是医疗质量的重要因素。总体而言，公立医院提供的护理质量低于非营利性医院，城市医院的质量得分高于农村地区的医院。具体而言，一阶差分回归结果表明，在医院盈利能力、财务杠杆和劳动力成本增加后的一年，心血管疾病患者的治疗质量会提高。
结果表明，当医院盈利更多、有能力利用债务为投资融资、支付更高工资以吸引更熟练的护士时，其医疗质量通常会提高。虽然追求利润促使医院提高所提供服务的数量和质量，但缺乏财务实力可能导致医疗服务标准降低，这意味着监测财务状况不佳的医院的医疗质量很重要。
