Long M J
Department of Health Administration, Eastern Michigan University, Ypsilanti 48197.
Am J Prev Med. 1985 Sep-Oct;1(5):41-5.
From a policy standpoint it is important to identify the level of output at which average cost per unit is at its lowest. If minimum optimum scale is achieved at a very high output level, it would suggest that monopoly conditions should be allowed to prevail. If, however, minimum optimum scale is achieved at a low level of output, more organizations would be able to survive, allowing for competition in the marketplace. Using data published by the Office of Health Maintenance Organizations, the relationship between size and average cost was examined in federally qualified staff, group, and Independent Practice Association (IPA) health maintenance organizations (HMOs) and minimum optimum scale was identified for each organization. The findings support the hypothesis that least cost size is achieved at the lowest level of output in IPA HMOs. The hypothesis that minimum optimum scale would be achieved at a lower level of output in group rather than in staff HMOs was not supported. This may be due to the practice of some staff HMOs of employing part-time, salaried providers and purchasing unique services from other providers.
从政策角度来看，确定单位平均成本处于最低水平时的产出水平非常重要。如果在非常高的产出水平上实现了最低最优规模，这将表明应允许垄断条件占主导地位。然而，如果在低产出水平上实现了最低最优规模，更多的组织将能够生存，从而允许市场竞争。利用健康维护组织办公室公布的数据，研究了联邦合格的员工型、团体型和独立执业协会（IPA）健康维护组织（HMO）中规模与平均成本之间的关系，并确定了每个组织的最低最优规模。研究结果支持了IPA HMO在最低产出水平实现最低成本规模的假设。团体型HMO比员工型HMO在更低产出水平实现最低最优规模的假设未得到支持。这可能是由于一些员工型HMO雇佣兼职受薪提供者并从其他提供者那里购买独特服务的做法。
