Kim Younhee, Lee Keon-Hyung, Choi Sung W
School of Public Affairs, Pennsylvania State University Harrisburg, Middletown, PA 17050, USA.
Askew School of Public Administration and Policy, Florida State University, Tallahassee, FL 32306, USA.
Healthcare (Basel). 2021 Jun 4;9(6):670. doi: 10.3390/healthcare9060670.
As health care costs and demands for health care services have been rising for decades in the United States, health care reforms have focused on increasing the performance of health care delivery. Competition has been considered as a mechanism to improve the quality of health care services and operational performance. Evidence on health care performance and market competition, however, has not sufficiently been reported to track its progress. The purpose of this study is twofold: First, we measure hospital performance over nine years, using the Malmquist Productivity Index. Second, we examine the impact of market competition on hospital efficiency in Pennsylvania, using a two-stage estimation procedure. The bootstrapped Malmquist productivity indices resulted in noticeable performance improvements. However, no steady performance trends were found during the course of nine years. In examining the impact of market competition, the bootstrapped panel Tobit analysis was applied after computing the efficiency scores with Data Envelopment Analysis. The results of the Tobit model found that hospitals run more efficiently in less competitive regions than in more competitive regions. The finding implies that hospitals underperforming in productivity growth should benchmark best practices of efficient hospitals to improve their productivity level. Another implication is that market competition would not be the best approach to effect the improvement of hospital efficiency in delivering health care services.
在美国，几十年来医疗保健成本和对医疗保健服务的需求一直在上升，医疗保健改革一直专注于提高医疗保健服务的绩效。竞争被视为提高医疗保健服务质量和运营绩效的一种机制。然而，关于医疗保健绩效和市场竞争的证据尚未得到充分报道，无法追踪其进展情况。本研究的目的有两个：第一，我们使用Malmquist生产率指数衡量九年来的医院绩效。第二，我们使用两阶段估计程序研究市场竞争对宾夕法尼亚州医院效率的影响。自抽样的Malmquist生产率指数显示出显著的绩效改善。然而，在九年的时间里没有发现稳定的绩效趋势。在研究市场竞争的影响时，在用数据包络分析计算效率得分后，应用了自抽样面板Tobit分析。Tobit模型的结果发现，在竞争较小的地区，医院的运营效率高于竞争激烈的地区。这一发现意味着，生产率增长表现不佳的医院应该以高效医院的最佳做法为基准，以提高其生产率水平。另一个含义是，市场竞争可能不是提高医院提供医疗保健服务效率的最佳方法。
