Pattison R V, Katz H M
N Engl J Med. 1983 Aug 11;309(6):347-53. doi: 10.1056/NEJM198308113090606.
The growth of investor-owned hospital-management companies represents the most dramatic change in the hospital industry in recent years. Whereas supporters of investor-owned chains suggest that their growth is attributable to operating efficiencies, critics suggest that it has resulted from pricing and marketing strategies. Using data supplied by the California Health Facilities Commission, we compared the economic performance of investor-owned and not-for-profit hospitals in California. There were three principal findings. First, during the study period both costs and charges were higher in for-profit than in not-for-profit hospitals, measured on the basis of either patient-days or admissions. Second, the for-profit chains have used aggressive marketing and pricing strategies to generate high rates of profitability and growth. Finally, the payer class of patients did not differ specifically according to the hospital-ownership category. We conclude that the recent dramatic growth of investor-owned hospital chains is attributable to the employment of managerial strategies that were well suited to the reimbursement system in effect during the period studied. As a result of recent changes in federal and state reimbursement, many of these reimbursement-maximization strategies have become obsolete. Whether the investor-owned chains will be able to adapt rapidly to this new reimbursement environment remains to be seen.
投资者所有的医院管理公司的发展是近年来医院行业最显著的变化。尽管投资者所有的连锁医院的支持者认为其发展归因于运营效率，但批评者则认为这是定价和营销策略的结果。利用加利福尼亚州卫生设施委员会提供的数据，我们比较了加利福尼亚州投资者所有的医院和非营利性医院的经济绩效。有三个主要发现。第一，在研究期间，无论是按住院日还是按入院人数衡量，营利性医院的成本和收费都高于非营利性医院。第二，营利性连锁医院采用激进的营销和定价策略来实现高利润率和高增长率。最后，患者的付款人类别并没有因医院所有权类别而有具体差异。我们得出结论，投资者所有的医院连锁近期的显著发展归因于采用了非常适合研究期间有效报销制度的管理策略。由于联邦和州报销政策最近发生了变化，许多这些报销最大化策略已经过时。投资者所有的连锁医院能否迅速适应这种新的报销环境还有待观察。
