Schramm C J
J Health Polit Policy Law. 1978 Fall;3(3):364-74. doi: 10.1215/03616878-3-3-364.
With the advent of various attempts to control hospital costs by direct state regulation, labor input costs have become a target of particular attention. This focus is due in part to the unique discretion administrators can exercise over labor factors, and in part to the large absolute part of hospital resources devoted to labor costs, conservatively estimated to be about 55 percent of total budget. This paper examines the impact of state efforts in prospectively setting rates on collective bargaining outcomes in the hospital sector. Specifically, bargaining in New York, Maryland and Connecticut is examined. The paper concludes that government attempts at controlling costs have, in all cases, required the regulatory bodies to consciously exert influence on the collective bargaining process. Further, while such attempts seem to be within the paradigm of multilateral bargaining, there are significant distinguishing features in the role hospital regulatory bodies play in the bargaining process. These variations from the multilateral paradigm may impede the long run ability of rate review efforts to control bargaining outcomes with respect to wages.
随着国家通过直接监管来控制医院成本的各种尝试的出现，劳动力投入成本已成为特别受关注的目标。这种关注部分是由于管理人员对劳动力因素可行使独特的酌处权，部分是由于医院资源中用于劳动力成本的绝对比例很大，保守估计约占总预算的55%。本文研究了国家前瞻性设定费率的努力对医院部门集体谈判结果的影响。具体而言，考察了纽约、马里兰州和康涅狄格州的谈判情况。本文的结论是，政府控制成本的尝试在所有情况下都要求监管机构有意识地对集体谈判过程施加影响。此外，虽然这种尝试似乎符合多边谈判的范式，但医院监管机构在谈判过程中所起的作用有显著的区别特征。这些与多边范式的差异可能会阻碍费率审查工作从长远角度控制工资方面的谈判结果的能力。
