Goes J B, Zhan C
School of Business and Public Administration, University of Alaska Southeast, Juneau 99801, USA.
Health Serv Res. 1995 Oct;30(4):507-30.
This study investigated the longitudinal relations between hospital financial performance outcomes and three hospital-physician integration strategies: physician involvement in hospital governance, hospital ownership by physicians, and the integration of hospital-physician financial relationships.
Using secondary data from the State of California, integration strategies in approximately 300 California short-term acute care hospitals were tracked over a ten-year period (1981-1990).
The study used an archival design. Hospital performance was measured on three dimensions: operational profitability, occupancy, and costs. Thirteen control variables were used in the analyses: market competition, affluence, and rurality; hospital ownership; teaching costs and intensity; multihospital system membership; hospital size; outpatient service mix; patient volume case mix; Medicare and Medicaid intensity; and managed care intensity.
DATA COLLECTION/EXTRACTION: Financial and utilization data were obtained from the State of California, which requires annual hospital reports. A series of longitudinal regressions tested the hypotheses.
Considerable variation was found in the popularity of the three strategies and their ability to predict hospital performance outcomes. Physician involvement in hospital governance increased modestly from 1981-1990, while ownership and financial integration declined significantly. Physician governance was associated with greater occupancy and higher operating margins, while financial integration was related to lower hospital operating costs. Direct physician ownership, particularly in small hospitals, was associated with lower operating margins and higher costs. Subsample analyses indicate that implementation of the Medicare prospective payment system in 1983 had a major impact on these relationships, especially on the benefits of financial integration.
The findings support the validity of hospital-physician financial integration efforts, and to a lesser extent the involvement of physicians in hospital governance. The results lend considerably less support for strategies built around direct physician ownership in hospitals, particularly since PPS implementation.
RELEVANCE/IMPACT: These findings challenge prior studies that found few financial benefits to hospital-physician integration prior to PPS implementation in 1983. The results imply that financial benefits of integration may take several years after implementation to emerge, are most salient in a managed care or managed competition environment, and vary by hospital size and multihospital system membership.
本研究调查了医院财务绩效结果与三种医院 - 医生整合策略之间的纵向关系，这三种策略分别是：医生参与医院治理、医生拥有医院所有权以及医院 - 医生财务关系的整合。
利用加利福尼亚州的二手数据，对约300家加利福尼亚州短期急性护理医院在十年期间（1981 - 1990年）的整合策略进行了跟踪。
该研究采用了档案设计。医院绩效从三个维度进行衡量：运营盈利能力、床位占用率和成本。在分析中使用了13个控制变量：市场竞争、富裕程度和农村地区情况；医院所有权；教学成本和强度；多医院系统成员资格；医院规模；门诊服务组合；患者数量病例组合；医疗保险和医疗补助强度；以及管理式医疗强度。
数据收集/提取：财务和利用数据来自加利福尼亚州，该州要求医院提交年度报告。通过一系列纵向回归对假设进行了检验。
发现这三种策略的普及程度及其预测医院绩效结果的能力存在相当大的差异。1981 - 1990年期间，医生参与医院治理略有增加，而所有权和财务整合则显著下降。医生治理与更高的床位占用率和更高的运营利润率相关，而财务整合与更低的医院运营成本相关。医生直接拥有所有权，特别是在小型医院，与更低的运营利润率和更高的成本相关。子样本分析表明，1983年医疗保险预期支付系统的实施对这些关系产生了重大影响，特别是对财务整合的益处。
研究结果支持医院 - 医生财务整合努力的有效性，在较小程度上支持医生参与医院治理。对于围绕医生直接拥有医院所有权构建的策略，研究结果提供的支持要少得多，特别是自预期支付系统实施以来。
相关性/影响：这些发现对之前的研究提出了挑战，之前的研究发现在1983年预期支付系统实施之前，医院 - 医生整合几乎没有财务益处。结果表明，整合的财务益处可能在实施后几年才会显现，在管理式医疗或管理式竞争环境中最为显著，并且因医院规模和多医院系统成员资格而异。
