Stith Sarah S
Department of Economics, The University of New Mexico, Albuquerque, NM, USA.
Int J Health Econ Manag. 2018 Mar;18(1):25-45. doi: 10.1007/s10754-017-9222-z. Epub 2017 Aug 30.
Organizational learning-by-doing implies that production outcomes improve with experience. Prior empirical research documents the existence of organizational learning-by-doing, but provides little insight into why some firms learn while others do not. Among the 124 U.S. liver transplant centers that opened between 1987 and 2009, this paper shows evidence of organizational learning-by-doing, but only shortly after entry. Significant heterogeneity exists with learning only evident among those firms entering early in the sample period when liver transplantation was an experimental medical procedure. Firms that learn begin with lower quality outcomes before improving to the level of firms that do not learn, suggesting that early patient outcomes depend on the ability of new entrants to import best practices from existing liver transplant programs. Knowledge of best practices became increasingly available over time through the dissemination of academic research and increasingly specialized training programs, so that between 1987 and 2009, 6 month post-transplant survival rates increased from 64 to 90% and evidence of organization-level learning-by-doing disappeared. The lack of any recent evidence of organizational learning-by-doing implies that common insurer experience requirements may be reducing access to health care in non-experimental complex medical procedures without an improvement in quality.
组织边干边学意味着生产成果会随着经验的积累而提高。先前的实证研究证实了组织边干边学的存在，但对于为何一些公司能够学习而另一些公司却不能，却几乎没有提供深入见解。在1987年至2009年间开业的124家美国肝脏移植中心中，本文显示了组织边干边学的证据，但仅在进入市场后不久。存在显著的异质性，只有在样本期早期进入的公司（当时肝脏移植是一种实验性医疗程序）中才明显存在学习现象。开始学习的公司在改善到未学习公司的水平之前，其初始质量结果较低，这表明早期患者的治疗结果取决于新进入者从现有肝脏移植项目中引入最佳实践的能力。随着时间的推移，通过学术研究的传播和日益专业化的培训项目，最佳实践的知识越来越容易获得，因此在1987年至2009年间，移植后6个月的生存率从64%提高到了90%，组织层面边干边学的证据也消失了。最近缺乏任何组织边干边学的证据意味着，普通保险公司的经验要求可能正在减少在非实验性复杂医疗程序中获得医疗服务的机会，而质量却没有提高。
