Mathematica, Oakland, California, USA.
JR Health Policy Consultants, LLC, Rockville, Maryland, USA.
Health Serv Res. 2020 Dec;55 Suppl 3(Suppl 3):1062-1072. doi: 10.1111/1475-6773.13584.
To examine system integration with physician specialties across markets and the association between local system characteristics and their patterns of physician integration.
Data come from the AHRQ Compendium of US Health Systems and IQVIA OneKey database.
We examined the change from 2016 to 2018 in the percentage of physicians in systems, focusing on primary care and the 10 most numerous nonhospital-based specialties across the 382 metropolitan statistical areas (MSAs) in the US. We also categorized systems by ownership, mission, and payment program participation and examined how those characteristics were related to their patterns of physician integration in 2018.
DATA COLLECTION/EXTRACTION METHODS: We examined local healthcare markets (MSAs) and the hospitals and physicians that are part of integrated systems that operate in these markets. We characterized markets by hospital and insurer concentration and systems by type of ownership and by whether they have an academic medical center (AMC), a 340B hospital, or accountable care organization.
Between 2016 and 2018, system participation increased for primary care and the 10 other physician specialties we examined. In 2018, physicians in specialties associated with lucrative hospital services were the most commonly integrated with systems including hematology-oncology (57%), cardiology (55%), and general surgery (44%); however, rates varied substantially across markets. For most specialties, high market concentration by insurers and hospital-systems was associated with lower rates of physician integration. In addition, systems with AMCs and publicly owned systems more commonly affiliated with specialties unrelated to the physicians' potential contribution to hospital revenue, and investor-owned systems demonstrated more limited physician integration.
Variation in physician integration across markets and system characteristics reflects physician and systems' motivations. These integration strategies are associated with the financial interests of systems and other strategic goals (eg, medical education, and serving low-income populations).
考察跨市场的医师专业系统整合情况，以及当地系统特征与医师整合模式之间的关系。
数据来自 AHRQ 美国卫生系统综合目录和 IQVIA OneKey 数据库。
我们考察了 2016 年至 2018 年期间系统中医生比例的变化，重点关注美国 382 个大都市统计区（MSAs）中初级保健和 10 个数量最多的非医院专科医生。我们还按所有权、使命和参与支付计划对系统进行了分类，并考察了这些特征与 2018 年医师整合模式的关系。
数据收集/提取方法：我们考察了当地医疗市场（MSAs）以及在这些市场中运营的整合系统中的医院和医生。我们通过医院和保险公司的集中程度以及系统的所有权类型来描述市场，包括是否有学术医疗中心（AMC）、340B 医院或责任医疗组织。
2016 年至 2018 年间，参与系统的初级保健医生和我们考察的其他 10 个医师专业的人数有所增加。2018 年，与利润丰厚的医院服务相关的专科医生与系统的整合最为普遍，包括血液学-肿瘤学（57%）、心脏病学（55%）和普通外科（44%）；然而，不同市场的比例差异很大。对于大多数专科医生来说，保险公司和医院系统的高市场集中与医生整合率较低有关。此外，拥有 AMC 和公有制系统的系统更常见于与医生对医院收入潜在贡献无关的专科医生，而投资者所有的系统则表现出更有限的医生整合。
市场和系统特征的医生整合差异反映了医生和系统的动机。这些整合策略与系统的财务利益和其他战略目标（如医学教育和服务低收入人群）有关。
