Choi T, Allison R F, Munson F
Med Care. 1985 Jul;23(7):855-71. doi: 10.1097/00005650-198507000-00003.
This article, by means of a path model, shows the impact of environment on state university hospital performance. The state environment is shown to affect systematically the intensity of local competition, the reputation of the medical school, the financial independence of the parent university, the allocation of indigent care dollars, the nature of governance and management, and the performance of the hospital. Results show that while certain environments are predictably more supportive of universities and university hospitals, these environments tend also to attract health care competition. Competition is shown to pressure hospitals into greater efficiency, but competition is shown also to hurt viability. But a hospital management that pays attention to the hospital environment is shown to help both efficiency and viability. The model explains respectively 37% and 46% of the variance in hospital efficiency and viability.
本文通过路径模型展示了环境对州立大学医院绩效的影响。研究表明，州环境会系统性地影响当地竞争的激烈程度、医学院的声誉、母体大学的财务独立性、贫困护理资金的分配、治理和管理的性质以及医院的绩效。结果显示，虽然某些环境可预见地更有利于大学和大学医院，但这些环境往往也会吸引医疗保健竞争。竞争会促使医院提高效率，但也会损害其生存能力。然而，注重医院环境的医院管理有助于提高效率和生存能力。该模型分别解释了医院效率和生存能力差异的37%和46%。
