Robinson J C, Luft H S
JAMA. 1987 Jun 19;257(23):3241-5.
Using 1982 data from 5732 US hospitals, we found that costs were substantially higher in hospitals operating in more competitive local environments than in hospitals in less competitive environments. After controlling for wage rates, patient case mix, state regulatory programs, and hospital teaching role, average costs per admission were found to be 26% higher in hospitals in the most competitive markets (more than ten hospitals within a 24-km radius) than in hospitals with no competitors within a 24-km radius. Average costs per patient-day were 15% higher in the most competitive markets than in hospitals with no neighbors. These findings on the cost implications of nonprice competition among hospitals suggest that the new modes of hospital payment will have a greater disruptive impact on hospital behavior in areas with many, rather than few, hospitals. In anticipating the effects of new modes of payment on hospital behavior, policymakers should consider the nature of quality competition as well as price competition within local markets.
利用1982年来自美国5732家医院的数据，我们发现，在竞争更为激烈的当地环境中运营的医院，其成本要比在竞争较弱环境中的医院高得多。在控制了工资率、患者病例组合、州监管项目以及医院的教学角色后，我们发现，在竞争最激烈的市场（半径24公里范围内有十多家医院）中，每家住院患者的平均成本比在半径24公里范围内没有竞争对手的医院高出26%。在竞争最激烈的市场中，每名患者每天的平均成本比没有相邻医院的医院高出15%。这些关于医院之间非价格竞争对成本影响的研究结果表明，新的医院支付模式将对医院众多地区而非医院较少地区的医院行为产生更大的颠覆性影响。在预测新支付模式对医院行为的影响时，政策制定者应考虑当地市场中质量竞争以及价格竞争的性质。
