Rice University, Houston, TX, USA.
Baylor College of Medicine, Houston, TX, USA.
Med Care Res Rev. 2020 Dec;77(6):538-548. doi: 10.1177/1077558719828938. Epub 2019 Feb 9.
Provider organizations are increasing in complexity, as hospitals acquire physician practices and physician organizations grow in size. At the same time, hospitals are merging with each other to improve bargaining power with insurers. We analyze 29 quality measures reported to the Center for Medicare and Medicaid Services' Hospital Compare database for 2008 to 2015 to test whether vertical integration between hospitals and physicians or increases in hospital market concentration influence patient outcomes. Vertical integration has a limited effect on a small subset of quality measures. Yet increased market concentration is strongly associated with reduced quality across all 10 patient satisfaction measures at the 95% confidence level ( < .05) and 6 of the 10 patient satisfaction measures remain statistically significant with a Bonferroni corrected value ( < .005). Regulators should continue to focus scrutiny on proposed hospital mergers, take steps to maintain competition, and reduce counterproductive barriers to entry.
医疗机构变得越来越复杂，因为医院收购医生诊所，医生组织的规模也在扩大。与此同时，医院之间也在合并，以提高与保险公司谈判的筹码。我们分析了 2008 年至 2015 年向医疗保险和医疗补助服务中心医院比较数据库报告的 29 项质量指标，以检验医院与医生之间的垂直整合或医院市场集中程度的增加是否会影响患者的治疗结果。垂直整合对一小部分质量指标的影响有限。然而，在所有 10 项患者满意度指标中，市场集中程度的增加与 95%置信水平下的所有患者满意度指标（<0.05）以及 6 项患者满意度指标的质量下降呈显著相关，这些指标在经过 Bonferroni 校正后（<0.005）仍具有统计学意义。监管机构应继续关注拟议中的医院合并，采取措施维持竞争，并减少对进入市场的不必要的阻碍。
