Beauvais Brad, Gilson Glen, Schwab Steve, Jaccaud Brittany, Pearce Taylor, Holmes Thomas
School of Health Administration, Texas State University, Encino Hall, Room 250A, 601 University Drive, San Marcos, TX 78666, USA.
U.S. Army-Baylor Graduate Program in Health and Business Administration, U.S. Army Medical Center of Excellence, Fort Sam Houston, TX 78234, USA.
Healthcare (Basel). 2020 May 17;8(2):135. doi: 10.3390/healthcare8020135.
In most consumer markets, higher prices generally imply increased quality. For example, in the automobile, restaurant, hospitality, and airline industries, higher pricing generally conveys a signal of complexity and superiority of a service or product. However, in the healthcare industry, there is room to challenge the price-quality connection as both health prices and health quality can be difficult to interpret. In the best of circumstances, health care costs, prices, and quality can often be difficult to isolate and measure. Recent efforts by the Trump Administration and the Center for Medicare and Medicaid Services (CMS) have required the pricing of hospital services to be more transparent. Specifically, hospital chargemaster (retail) prices must now be available to the public. However, many continue to question if the pricing of health care services reflects the quality of service delivery. This research focuses on investigating the prices hospitals charge for their services in relation to the costs incurred and the association with the quality of care provided. By analyzing data from a nationwide sample of U.S. hospitals, this study considers the relationship between hospital pricing (as measured by the charge-to-cost ratio) and hospital quality performance as measured by the Value Based Purchasing Total Performance Score (TPS) and its associated sub-domains. Results of the study indicate that hospital prices, as measured by our primary independent variable of interest, the charge-to-cost ratio, are significantly and negatively associated with Total Performance Score, Patient Experience, and the Efficiency and Cost Reduction domains. A marginal statistically significant positive association is shown in the Clinical Care domain. The findings indicate that unlike most other industries, in medicine, higher pricing compared to cost does not necessarily associate with higher quality and, in fact, might indicate the opposite. The results of this study suggest that purchasers of healthcare, at all levels, have justification in challenging the pricing of healthcare services considering the quality scores available in the public domain.
在大多数消费市场中，较高的价格通常意味着质量的提升。例如，在汽车、餐饮、酒店和航空业，较高的定价通常传递出服务或产品的复杂性和优越性的信号。然而，在医疗行业，价格与质量的关联存在可质疑之处，因为医疗价格和医疗质量都可能难以解读。在最佳情况下，医疗成本、价格和质量往往也很难区分和衡量。特朗普政府和医疗保险与医疗补助服务中心（CMS）近期的举措要求医院服务定价更加透明。具体而言，医院收费主表（零售）价格现在必须向公众公开。然而，许多人仍在质疑医疗服务定价是否反映了服务提供的质量。本研究聚焦于调查医院收取的服务价格与所产生的成本之间的关系，以及与所提供医疗质量的关联。通过分析来自美国全国范围内医院样本的数据，本研究考察了医院定价（以收费成本比衡量）与以基于价值的采购总体绩效得分（TPS）及其相关子领域衡量的医院质量表现之间的关系。研究结果表明，以我们主要关注的自变量收费成本比衡量的医院价格，与总体绩效得分、患者体验以及效率和成本降低领域显著负相关。在临床护理领域呈现出边际统计学上显著的正相关。研究结果表明，与大多数其他行业不同，在医疗领域，相对于成本而言较高的定价并不一定与较高的质量相关，事实上可能恰恰相反。本研究结果表明，各级医疗服务购买者有理由根据公开领域可得的质量得分对医疗服务定价提出质疑。
