Shih Ya-Chen Tina, Shen Chan, Hu Jim C
Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Value Health. 2017 Sep;20(8):1221-1225. doi: 10.1016/j.jval.2017.05.010. Epub 2017 Jun 20.
The aim of this study was to examine the association between ownership of robotic surgical systems and hospital profit margins.
This study used hospital annual utilization data, annual financial data, and discharge data for year 2011 from the California Office of Statewide Health Planning and Development. We first performed bivariate analysis to compare mean profit margin by hospital and market characteristics and to examine whether these characteristics differed between hospitals that had one or more robotic surgical systems in 2011 and those that did not. We applied the t test and the F test to compare mean profit margin between two groups and among three or more groups, respectively. We then conducted multilevel logistic regression to determine the association between ownership of robotic surgical systems and having a positive profit margin after controlling for other hospital and market characteristics and accounting for possible correlation among hospitals located within the same market.
The study sample included 167 California hospitals with valid financial information. Hospitals with robotic surgical systems tended to report more favorable profit margins. However, multilevel logistic regression showed that this relationship (an association, not causality) became only marginally significant (odds ratio [OR] = 6.2; P = 0.053) after controlling for other hospital characteristics, such as ownership type, teaching status, bed size, and surgical volumes, and market characteristics, such as total number of robotic surgical systems owned by other hospitals in the same market area.
As robotic surgical systems become widely disseminated, hospital decision makers should carefully evaluate the financial and clinical implications before making a capital investment in this technology.
本研究旨在探讨机器人手术系统的拥有情况与医院利润率之间的关联。
本研究使用了加利福尼亚州全州卫生规划与发展办公室提供的2011年医院年度使用数据、年度财务数据和出院数据。我们首先进行了双变量分析，以比较不同医院和市场特征下的平均利润率，并考察在2011年拥有一台或多台机器人手术系统的医院与未拥有的医院之间这些特征是否存在差异。我们分别应用t检验和F检验来比较两组之间以及三组或更多组之间的平均利润率。然后，我们进行了多水平逻辑回归分析，以确定在控制了其他医院和市场特征并考虑了同一市场内医院之间可能存在的相关性之后，机器人手术系统的拥有情况与利润率为正之间的关联。
研究样本包括167家拥有有效财务信息的加利福尼亚州医院。拥有机器人手术系统的医院往往报告出更有利的利润率。然而，多水平逻辑回归分析表明，在控制了其他医院特征（如所有制类型、教学状况、床位规模和手术量）以及市场特征（如同一个市场区域内其他医院拥有的机器人手术系统总数）之后，这种关系（一种关联，而非因果关系）仅在边缘上具有统计学意义（优势比[OR]=6.2；P=0.053）。
随着机器人手术系统的广泛普及，医院决策者在对这项技术进行资本投资之前，应仔细评估其财务和临床影响。
