Robinson J C, Garnick D W, McPhee S J
N Engl J Med. 1987 Jul 9;317(2):85-90. doi: 10.1056/NEJM198707093170205.
Using 1983 data on 3720 nonfederal short-term hospitals, we analyzed the influence of local market competition and state regulatory programs on the availability of percutaneous transluminal coronary angioplasty and coronary-artery bypass surgery. The degree of competition for patients with heart disease was measured in terms of the number of hospitals in the local market area that maintained a cardiac catheterization laboratory or facility for open-heart surgery. When the patient case mix and the hospital's teaching role were controlled for, institutions with more than 20 competitors in the local area were 166 percent more likely to offer coronary angioplasty (P less than 0.0001) and 147 percent more likely to offer bypass surgery (P less than 0.0001) than hospitals with no competitors in the local market. Four fifths of the hospitals performing bypass surgery whose annual volume was less than 200 had one or more neighboring hospitals with a facility for open-heart surgery. State rate-regulation programs in New York, New Jersey, Connecticut, Massachusetts, and Maryland significantly reduced the availability of both procedures, with the greatest regulatory effects being observed in the most competitive hospital markets. We conclude that in the period under consideration, competition encouraged and regulation discouraged the proliferation of these cardiac services.
利用1983年3720家非联邦短期医院的数据，我们分析了当地市场竞争和州监管计划对经皮腔内冠状动脉成形术和冠状动脉搭桥手术可及性的影响。心脏病患者的竞争程度是根据当地市场区域内设有心导管实验室或心脏直视手术设施的医院数量衡量的。在控制了患者病例组合和医院教学作用后，当地有20多个竞争对手的机构提供冠状动脉成形术的可能性比当地没有竞争对手的医院高166%（P小于0.0001），提供搭桥手术的可能性高147%（P小于0.0001）。年手术量少于200例的进行搭桥手术的医院中，五分之四的医院有一家或多家邻近医院设有心脏直视手术设施。纽约、新泽西、康涅狄格、马萨诸塞和马里兰州的州费率监管计划显著降低了这两种手术的可及性，在竞争最激烈的医院市场观察到最大的监管效果。我们得出结论，在所考虑的时期内，竞争促进了这些心脏服务的普及，而监管则起到了抑制作用。
