Health Care Administration, University of Wisconsin-Milwaukee, Northwest Quadrant B 6428, 2025 E Newport Avenue, Milwaukee, WI, 53211-2906, USA.
BMC Health Serv Res. 2020 Sep 17;20(1):880. doi: 10.1186/s12913-020-05728-y.
The purpose of this study is to assess the influences of market structure on hospitals' strategic decision to duplicate or differentiate services and to assess the relationship of duplication and differentiation to hospital performance. This study is different from previous research because it examines how a hospital decides which services to be duplicated or differentiated in a dyadic relationship embedded in a complex competitive network.
We use Linear Structural Equations (LISREL) to simultaneously estimate the relationships among market structure, duplicated and differentiated services, and performance. All non-federal, general acute hospitals in urban counties in the United States with more than one hospital are included in the sample (n = 1726). Forty-two high-tech services are selected for the study. Data are compiled from the American Hospital Association Annual Survey of Hospitals, Area Resource File, and CMS cost report files. State data from HealthLeaders-InterStudy for 2015 are also used.
The findings provide support that hospitals duplicate and differentiate services relative to rivals in a local market. Size asymmetry between hospitals is related to both service duplication (negatively) and service differentiation (positively). With greater size asymmetry, a hospital utilizes its valuable resources for its own advantage to thwart competition from rivals by differentiating more high-tech services and reducing service duplication. Geographic distance is positively related to service duplication, with duplication increasing as distance between hospitals increases. Market competition is associated with lower service duplication. Both service differentiation and service duplication are associated with lower market share, higher costs, and lower profits.
The findings underscore the role of market structure as a check and balance on the provision of high-tech services. Hospital management should consider cutting back some services that are oversupplied and/or unprofitable and analyze the supply and demand in the market to avoid overdoing both service duplication and service differentiation.
本研究旨在评估市场结构对医院服务复制或差异化的战略决策的影响，并评估复制和差异化与医院绩效的关系。本研究与以往研究的不同之处在于，它考察了医院在复杂竞争网络中嵌入的对偶关系中，如何决定复制或差异化哪些服务。
我们使用线性结构方程（LISREL）同时估计市场结构、复制和差异化服务以及绩效之间的关系。样本包括美国城市县中拥有一家以上医院的所有非联邦、普通急症医院（n=1726）。选择了 42 种高科技服务进行研究。数据来自美国医院协会年度医院调查、区域资源文件和 CMS 成本报告文件。还使用了 HealthLeaders-InterStudy 2015 年的州数据。
研究结果提供了支持，即医院相对于当地市场的竞争对手复制和差异化服务。医院之间的规模不对称与服务复制（负相关）和服务差异化（正相关）有关。随着规模不对称程度的增加，医院利用其有价值的资源为自己的利益服务，通过差异化更多的高科技服务和减少服务复制来挫败竞争对手的竞争。地理距离与服务复制呈正相关，随着医院之间距离的增加，复制服务的数量增加。市场竞争与服务复制减少有关。服务差异化和服务复制都与较低的市场份额、较高的成本和较低的利润有关。
研究结果强调了市场结构作为高科技服务提供的制衡作用。医院管理层应考虑削减一些供应过剩和/或无利可图的服务，并分析市场的供求情况，以避免服务复制和差异化过度。
