Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Surgery, Duke University Medical Center, Durham, NC, United States.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Am J Surg. 2018 Apr;215(4):549-556. doi: 10.1016/j.amjsurg.2017.10.028. Epub 2017 Oct 23.
Increasing hospital market concentration (with concomitantly decreasing hospital market competition) may be associated with rising hospital prices. Hospital markup - the relative increase in price over costs - has been associated with greater hospital market concentration.
Patients undergoing a cardiothoracic or gastrointestinal procedure in the 2008-2011 Nationwide Inpatient Sample (NIS) were identified and linked to Hospital Market Structure Files. The association between market concentration, hospital markup and hospital for-profit status was assessed using mixed-effects log-linear models.
A weighted total of 1,181,936 patients were identified. In highly concentrated markets, private for-profit status was associated with an 80.8% higher markup compared to public/private not-for-profit status (95%CI: +69.5% - +96.9%; p < 0.001). However, private for-profit status in highly concentrated markets was associated with only a 62.9% higher markup compared to public/private not-for-profit status in unconcentrated markets (95%CI: +45.4% - +81.1%; p < 0.001).
Hospital for-profit status modified the association between hospitals' market concentration and markup. Government and private not-for-profit hospitals employed lower markups in more concentrated markets, whereas private for-profit hospitals employed higher markups in more concentrated markets.
医院市场集中（随之而来的是医院市场竞争的减少）可能与医院价格上涨有关。医院加价 - 价格相对于成本的相对增加 - 与更大的医院市场集中有关。
在 2008-2011 年全国住院患者样本（NIS）中确定并链接到医院市场结构文件中接受心胸或胃肠道手术的患者。使用混合效应对数线性模型评估市场集中、医院加价和医院营利性地位之间的关联。
确定了加权总数为 1,181,936 名患者。在高度集中的市场中，私立营利性医院的加价率比公立/私立非营利性医院高 80.8%（95%CI：+69.5%至+96.9%；p<0.001）。然而，在高度集中的市场中，私立营利性医院的加价率仅比非集中市场中的公立/私立非营利性医院高 62.9%（95%CI：+45.4%至+81.1%；p<0.001）。
医院营利性地位改变了医院市场集中与加价之间的关系。政府和私人非营利性医院在集中程度更高的市场中采用了较低的加价率，而私立营利性医院在集中程度更高的市场中采用了更高的加价率。
