Post Brady, Buchmueller Tom, Ryan Andrew M
1 University of Michigan, Ann Arbor, MI, USA.
Med Care Res Rev. 2018 Aug;75(4):399-433. doi: 10.1177/1077558717727834. Epub 2017 Aug 29.
Hospital-physician vertical integration is on the rise. While increased efficiencies may be possible, emerging research raises concerns about anticompetitive behavior, spending increases, and uncertain effects on quality. In this review, we bring together several of the key theories of vertical integration that exist in the neoclassical and institutional economics literatures and apply these theories to the hospital-physician relationship. We also conduct a literature review of the effects of vertical integration on prices, spending, and quality in the growing body of evidence ( n = 15) to evaluate which of these frameworks have the strongest empirical support. We find some support for vertical foreclosure as a framework for explaining the observed results. We suggest a conceptual model and identify directions for future research. Based on our analysis, we conclude that vertical integration poses a threat to the affordability of health services and merits special attention from policymakers and antitrust authorities.
医院与医生的纵向整合正在兴起。虽然可能会提高效率，但新出现的研究引发了人们对反竞争行为、支出增加以及对质量影响不确定的担忧。在本综述中，我们汇集了新古典经济学和制度经济学文献中存在的几个纵向整合关键理论，并将这些理论应用于医院与医生的关系。我们还对越来越多的证据（n = 15）中纵向整合对价格、支出和质量的影响进行了文献综述，以评估这些框架中哪些具有最强的实证支持。我们发现纵向排斥作为解释观察结果的框架有一定支持。我们提出了一个概念模型，并确定了未来研究的方向。基于我们的分析，我们得出结论，纵向整合对医疗服务的可负担性构成威胁，值得政策制定者和反垄断当局特别关注。
