Chakravarty Sujoy
Center for State Health Policy, Rutgers University, 112 Paterson Street, Room 548, New Brunswick, NJ, 08901, USA.
Int J Health Econ Manag. 2016 Jun;16(2):103-131. doi: 10.1007/s10754-015-9181-1. Epub 2015 Nov 18.
The U.S. hospital industry has recently witnessed a number of policy changes aimed at aligning hospital payments to costs and these can be traced to significant concerns regarding selection of profitable patients and procedures by physician-owned specialty hospitals. The policy responses to specialty hospitals have alternated between payment system reforms and outright moratoriums on hospital operations including one in the recently enacted Affordable Care Act. A key issue is whether physician-owned specialty hospitals pose financial strain on the larger group of general hospitals through cream-skimming of profitable patients, yet there is no study that conducts a systematic analysis relating such selection behavior by physician-owners to financial impacts within hospital markets. The current paper takes into account heterogeneity in specialty hospital behavior and finds some evidence of their adverse impact on profit margins of competitor hospitals, especially for-profit hospitals. There is also some evidence of hospital consolidation in response to competitive pressures by specialty hospitals. Overall, these findings underline the importance of the payment reforms aimed at correcting distortions in the reimbursement system that generate incentives for risk-selection among providers groups. The identification techniques will also inform empirical analysis on future data testing the efficacy of these payment reforms.
美国医院行业最近经历了一系列政策变革，旨在使医院支付与成本保持一致，这些变革可追溯到人们对医生拥有的专科医院挑选盈利性患者和手术的重大担忧。针对专科医院的政策应对措施在支付系统改革和直接暂停医院运营之间交替，其中包括最近颁布的《平价医疗法案》中的一项措施。一个关键问题是，医生拥有的专科医院是否通过挑选盈利性患者而给更大的综合医院群体带来财务压力，但尚无研究对医生所有者的这种挑选行为与医院市场内的财务影响之间的关系进行系统分析。本文考虑了专科医院行为的异质性，发现了一些证据表明它们对竞争医院的利润率有不利影响，尤其是对营利性医院。也有一些证据表明，医院会因专科医院的竞争压力而进行合并。总体而言，这些发现凸显了支付改革的重要性，这些改革旨在纠正报销系统中的扭曲现象，因为这些扭曲会促使供应商群体进行风险选择。识别技术也将为未来检验这些支付改革效果的数据的实证分析提供参考。
