Robinson J C
School of Public Health, University of California, Berkeley 94720.
Milbank Q. 1994;72(2):259-75.
The American hospital faces two different possible futures. In one, the hospital continues to expand into outpatient, home health, and long-term-care services and remains the center of the changing health care system. In the other, competition in each of these domains from independent health plans, which do not have to contend with the high wages, technological imperatives, and bureaucratic inertia of large hospital organizations, pushes the hospital to a peripheral role as provider of ever-diminishing acute inpatient services. The choice between these two futures will be made based on the efficiencies of vertical integration relative to market contracting. Transactions cost economics is used to analyze the changing boundaries of the hospital organization, particularly with respect to outpatient diagnostic and surgical clinics, home health agencies, and long-term-care facilities.
美国医院面临着两种不同的可能未来。其一，医院继续扩展至门诊、家庭医疗和长期护理服务领域，并依旧是不断变化的医疗体系的核心。其二，在这些领域中，独立健康计划的竞争使得医院沦为提供日益减少的急性住院服务的边缘角色，因为独立健康计划无需应对大型医院组织的高工资、技术需求和官僚惰性。这两种未来的选择将基于纵向整合相对于市场契约的效率来做出。交易成本经济学被用于分析医院组织不断变化的边界，尤其是在门诊诊断和外科诊所、家庭医疗机构以及长期护理设施方面。
