Elliott S. Fisher (
Stephen M. Shortell is the Blue Cross of California Distinguished Professor of Health Policy and Management Emeritus and Professor of the Graduate School, codirector of the Center for Healthcare Organizational and Innovation Research, and dean emeritus at the School of Public Health, all at the University of California Berkeley, in Berkeley, California.
Health Aff (Millwood). 2020 Aug;39(8):1302-1311. doi: 10.1377/hlthaff.2019.01813.
Health systems continue to grow in size. Financial integration-the ownership of hospitals or physician practices-often has anticompetitive effects that contribute to the higher prices for health care seen in the US. To determine whether the potential harms of financial integration are counterbalanced by improvements in quality, we surveyed nationally representative samples of hospitals ( = 739) and physician practices ( = 2,189), stratified according to whether they were independent or were owned by complex systems, simple systems, or medical groups. The surveys included nine scales measuring the level of adoption of diverse, quality-focused care delivery and payment reforms. Scores varied widely across hospitals and practices, but little of this variation was explained by ownership status. Quality scores favored financially integrated systems for four of nine hospital measures and one of nine practice measures, but in no case favored complex systems. Greater financial integration was generally not associated with better quality.
医疗体系的规模持续扩大。财务整合（即医院或医师执业的所有权）往往具有反竞争的效果，这也是导致美国医疗保健价格上涨的原因之一。为了确定财务整合的潜在危害是否被质量的提高所抵消，我们对全国范围内具有代表性的医院样本（n=739）和医师执业样本（n=2189）进行了调查，这些样本根据其是否独立或归属于复杂系统、简单系统或医疗集团进行了分层。调查包括九个衡量不同、以质量为重点的医疗服务和支付改革采用程度的量表。医院和执业机构的得分差异很大，但所有权状况并不能解释这种差异。在九个医院指标中有四个和九个执业指标中有一个的质量得分偏向财务整合系统，但在任何情况下都不偏向复杂系统。一般来说，更大程度的财务整合并不与更高的质量相关。
