School of Public Health, UC-Berkeley, Berkeley, California, USA.
The Dartmouth Institute for Health Policy, Dartmouth University, Lebanon, New Hampshire, USA.
Health Serv Res. 2021 Jun;56(3):453-463. doi: 10.1111/1475-6773.13621. Epub 2021 Jan 11.
Building on the original taxonomy of hospital-based health systems from 20 years ago, we develop a new taxonomy to inform emerging public policy and practice developments.
The 2016 American Hospital Association's (AHA) Annual Survey; the 2016 IQVIA Healthcare Organizations and Systems (HCOS) database; and the 2017-2018 National Survey of Healthcare Organizations and Systems (NSHOS).
Cluster analysis of the 2016 AHA Annual Survey data to derive measures of differentiation, centralization, and integration to create categories or types of hospital-based health systems.
Principal components factor analysis with varimax rotation generating the factors used in the cluster algorithms.
Among the four cluster types, 54% (N = 202) of systems are decentralized (-0.35) and relatively less differentiated (-0.37); 23% of systems (N = 85) are highly differentiated (1.28) but relatively decentralized (-0.29); 15% (N = 57) are highly centralized (2.04) and highly differentiated (0.65); and approximately 9 percent (N = 33) are least differentiated (-1.35) and most decentralized (-0.64). Despite differences in calculation, the Highly Centralized, Highly Differentiated System Cluster and the Undifferentiated, Decentralized System Cluster were similar to those identified 20 years ago. The other two system clusters contained similarities as well as differences from those 20 years ago. Overall, 82 percent of the systems remain relatively decentralized suggesting they operate largely as holding companies allowing autonomy to individual hospitals operating within the system.
The new taxonomy of hospital-based health systems bears similarities as well as differences from 20 years ago. Important applications of the taxonomy for addressing current challenges facing the healthcare system, such as the transition to value-based payment models, continued consolidation, and the growing importance of the social determinants of health, are highlighted.
在 20 年前基于医院的卫生系统原始分类法的基础上，我们制定了一个新的分类法，以告知新兴的公共政策和实践发展。
2016 年美国医院协会（AHA）年度调查；2016 年 IQVIA 医疗机构和系统（HCOS）数据库；以及 2017-2018 年全国医疗机构和系统调查（NSHOS）。
对 2016 年 AHA 年度调查数据进行聚类分析，得出差异化、集中化和一体化的衡量标准，从而创建医院为基础的卫生系统的类别或类型。
主成分因子分析，采用方差极大旋转生成聚类算法中使用的因子。
在这四个聚类类型中，54%（N=202）的系统是分散的（-0.35），差异化程度相对较低（-0.37）；23%的系统（N=85）是高度差异化的（1.28），但相对分散（-0.29）；15%（N=57）是高度集中的（2.04）和高度差异化的（0.65）；大约 9%（N=33）的系统是差异化程度最低的（-1.35）和最分散的（-0.64）。尽管计算方法不同，但高度集中、高度差异化的系统聚类和无差异化、分散的系统聚类与 20 年前确定的聚类相似。另外两个系统聚类既有相似之处，也有与 20 年前不同之处。总体而言，82%的系统仍然相对分散，这表明它们主要作为控股公司运作，允许系统内的各个医院保持自主权。
基于医院的卫生系统的新分类法与 20 年前的分类法既有相似之处，也有不同之处。该分类法对解决医疗保健系统当前面临的挑战，如向基于价值的支付模式过渡、持续整合以及健康的社会决定因素日益重要等，具有重要的应用。
