Chernew M
School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor 48109-2029, USA.
Inquiry. 1995 Summer;32(2):143-54.
Concentration in the hospital market could limit the success of health care reform strategies that rely on managed care to constrain costs. Hospital market capacity also is important because capacity affects both costs and the degree of price competition. Because managed care plans, particularly non-individual practice association (non-IPA) model HMOs, practice a less hospital-intensive style of care, consolidation and downsizing in the hospital market potentially will accompany managed care growth, influencing the long-run effectiveness of managed care cost-containment strategies. Using Standard Metropolitan Statistical Area (SMSA) data from 1982 and 1987, a 10-percentage point increase in non-IPA HMO market share is estimated to reduce the number of hospitals by about 4%, causing an approximate 5% reduction in the number of hospital beds. No statistically significant relationship is found between non-IPA HMO penetration rates and hospital occupancy rates.
医院市场的集中化可能会限制依赖管理式医疗来控制成本的医疗改革策略的成功。医院市场容量也很重要，因为容量会影响成本和价格竞争程度。由于管理式医疗计划，特别是非个体执业协会（non-IPA）模式的健康维护组织（HMO），采用的是医院密集程度较低的护理方式，医院市场的合并和缩减规模可能会伴随管理式医疗的增长，从而影响管理式医疗成本控制策略的长期有效性。利用1982年和1987年标准大都市统计区（SMSA）的数据估计，非IPA HMO市场份额每增加10个百分点，医院数量会减少约4%，病床数量会减少约5%。未发现非IPA HMO渗透率与医院入住率之间存在统计学上的显著关系。
