Kaiser Florian, Schmid Andreas, Schlüchtermann Jörg
Faculty of Law, Business and Economics, University of Bayreuth, Bayreuth, Germany.
Faculty of Law, Business and Economics, University of Bayreuth, Bayreuth, Germany.
Soc Sci Med. 2020 Feb 5;249:112831. doi: 10.1016/j.socscimed.2020.112831.
Reflecting the increasing relevance of quality outcomes for hospital payments, some hospital boards have promoted physicians into top-management positions. So far, however, the literature regarding the impact of physician leadership on care quality or cost is limited. The aim of this study is to examine the link between the educational background of a hospital's CEO and its performance in terms of medical quality and financial success. Examining data of 370 German hospitals for the year 2016, this study uses the second largest sample of its kind and the largest for a single country. Multivariate regression analysis with matching is used to model the effect of the CEO's education, controlling for tenure, competition, hospital size and ownership. We find that physician-led hospitals have lower in-hospital mortality rates for pneumonia and higher patient satisfaction (at the 5% and 1% significance level, respectively). In contrast, institutions led by managers with economics or business degrees have better financial performance (at the 10% significance level) and superior outcomes for hip and knee surgeries (at the 1% and 10% significance level). Our findings support prior results regarding financial outcomes and mortality. However, including a broad spectrum of measures for clinical quality, we draw a more nuanced picture that does not point to the straightforward interpretation that physician CEOs lead to superior medical quality.
鉴于质量结果对医院支付的相关性日益增加，一些医院董事会已将医生提拔到高层管理职位。然而，到目前为止，关于医生领导力对医疗质量或成本影响的文献有限。本研究的目的是检验医院首席执行官的教育背景与其在医疗质量和财务成功方面的表现之间的联系。本研究考察了2016年370家德国医院的数据，使用了同类研究中第二大样本且是单个国家最大的样本。采用匹配的多元回归分析来模拟首席执行官教育程度的影响，并控制任期、竞争、医院规模和所有权等因素。我们发现，由医生领导的医院肺炎患者的院内死亡率较低，患者满意度较高（分别在5%和1%的显著性水平上）。相比之下，由拥有经济学或商学学位的管理人员领导的机构财务表现更好（在10%的显著性水平上），髋关节和膝关节手术的结果更优（在1%和10%的显著性水平上）。我们的研究结果支持了之前关于财务结果和死亡率的研究结果。然而，通过纳入广泛的临床质量指标，我们描绘了一幅更为细致入微的图景，并不支持医生担任首席执行官会带来卓越医疗质量的简单解读。
