Department of Health Policy and Management, Tulane University, New Orleans.
Usha Kundu, MD College of Health, University of West Florida, Pensacola.
J Healthc Manag. 2024;69(5):321-334. doi: 10.1097/JHM-D-23-00266. Epub 2024 Sep 6.
The U.S. hospital sector is experiencing record levels of integration, with more than half of U.S. physicians and nearly three quarters of all hospitals affiliated with one of slightly more than 630 health systems. However, there is growing evidence to suggest that health system integration is associated with more expensive and lower quality care. The goal of this research is to explore the associations between forms of health system integration and hospital patient experience scores.
A cross-section of data for the year 2019 was assembled and analyzed from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experience survey. Data from the Compendium of US Health Systems, published by the Agency for Healthcare Research and Quality (AHRQ), and the American Hospital Association (AHA) Annual Survey were used to obtain independent variables and hospital-level covariates. A series of multivariable regressions was used to explore the associations between forms of health system integration and hospital patient experience scores across three domains: overall impression of the hospital; experiences with staff; and the hospital environment. Forms of both horizontal integration (i.e., number of hospitals owned by hospital-based health systems) and vertical integration (i.e., physician-hospital integration, nursing home ownership, accountable care organization [ACO] participation, group purchasing, contract management, offering insurance products, and investor ownership) were explored.
Although horizontal integration was not associated with any meaningful differences in patient experience scores, health systems with physician-hospital integration were associated with overall impression scores that were 2 percentage points higher than systems without physician integration. Similarly, contract management and membership in a group purchasing organization were associated with overall impression and environment scores that were 2 to 3 percentage points higher than hospitals that did not engage in those forms of integration. By contrast, investor ownership was associated with a 5% lower score for overall patient experience compared with other forms of ownership.
The findings of this study suggest that hospitals in more vertically integrated systems may have higher patient experience scores than independent hospitals and those that belong exclusively to horizontally integrated systems. Thus, there are elements of vertical integration that could benefit patients and be worth pursuing. Conversely, higher degrees of horizontal integration in the form of multihospital ownership may not be of any benefit to patients and should be pursued with caution.
美国医院行业正经历着创纪录的整合水平，超过一半的美国医生和近四分之三的医院与略多于 630 个卫生系统中的一个相关联。然而，越来越多的证据表明，卫生系统的整合与更昂贵和更低质量的护理有关。本研究的目标是探索卫生系统整合形式与医院患者体验评分之间的关系。
从医院消费者评估医疗保健提供者和系统（HCAHPS）患者体验调查中收集了 2019 年的横断面数据，并进行了分析。使用美国医疗保健研究与质量局（AHRQ）出版的《美国卫生系统概览》和美国医院协会（AHA）年度调查中的数据来获取独立变量和医院层面的协变量。使用一系列多变量回归来探索卫生系统整合形式与三个领域的医院患者体验评分之间的关系：对医院的总体印象；与员工的互动；以及医院环境。探讨了水平整合（即医院为医院为基础的卫生系统所拥有的医院数量）和垂直整合（即医生-医院整合、疗养院所有权、责任医疗组织[ACO]参与、团体采购、合同管理、提供保险产品和投资者所有权）的形式。
尽管水平整合与患者体验评分没有任何显著差异相关，但具有医生-医院整合的卫生系统与整体印象评分相关，比没有医生整合的系统高 2 个百分点。同样，合同管理和加入团体采购组织与整体印象和环境评分相关，比没有参与这些整合形式的医院高 2 到 3 个百分点。相比之下，与其他所有权形式相比，投资者所有权与整体患者体验评分低 5%相关。
本研究的结果表明，在垂直整合程度较高的系统中的医院可能比独立医院和完全属于水平整合系统的医院拥有更高的患者体验评分。因此，垂直整合的某些方面可能对患者有益，值得追求。相反，多医院所有权形式的更高程度的水平整合可能对患者没有任何好处，应该谨慎追求。
