Friedman B, Shortell S
Hospital Research and Educational Trust, Chicago, IL 60611.
Health Serv Res. 1988 Jun;23(2):237-67.
This article analyzes determinants of cost and profitability, including the influence of Medicare prospective payment (PPS), between 1983 and 1985 for nearly 300 hospitals belonging to investor-owned (IO) and not-for-profit (NFP) systems. Using approaches that assure comparability of financial data, and including case mix, quality, competition, and regulation measures, the findings indicate that (1) in both years, competitive environment, case mix, age of facility, and scope of diversified services were important determinants of average cost, while a process measure of quality was insignificant and the independent effect of ownership type was insignificant for cost; (2) effects of HMO competition and hospital strategy were stronger in 1985 than in 1983; (3) operating margins for all types of hospitals showed increases, with a somewhat greater improvement for NFP system members; and (4) significantly greater declines in volume of care occurred for IO system members. Implications for future research are discussed.
本文分析了1983年至1985年间近300家属于投资者所有（IO）和非营利（NFP）系统的医院的成本和盈利能力的决定因素，包括医疗保险预期支付（PPS）的影响。采用确保财务数据可比性的方法，并纳入病例组合、质量、竞争和监管措施，研究结果表明：（1）在这两年中，竞争环境、病例组合、设施年限和多元化服务范围是平均成本的重要决定因素，而质量的过程指标无关紧要，所有权类型对成本的独立影响也不显著；（2）1985年健康维护组织（HMO）竞争和医院战略的影响比1983年更强；（3）所有类型医院的营业利润率都有所提高，非营利系统成员的改善幅度略大；（4）投资者所有系统成员的护理量下降幅度明显更大。文中还讨论了对未来研究的启示。
