Hadley J, Zuckerman S, Iezzoni L I
Georgetown University Institute for Health Care Research and Policy, Washington, DC, USA.
Med Care. 1996 Mar;34(3):205-19. doi: 10.1097/00005650-199603000-00002.
Using data from the American Hospital Association and the Medicare program, the authors analyzed the effects of financial pressure and market competition on changes in several measures of performance of 1,435 acute care hospitals between 1987 and 1989. Over the observation period, the least profitable hospitals constrained their growth in total expenses to half that for the most profitable hospitals (13.3% versus 27.6%) by limiting the growth of their staffs and their total assets. These changes were associated with a reduction in inefficiency of 1.8% (11.2%) compared with a very slight increase in inefficiency for the highest profit group. Similarly, hospitals in highly competitive markets controlled expenses relative to those in the least competitive areas. However, they also experienced slower revenue growth than did less competitive hospitals so that, in relative terms, their profit rates fell. The authors found no evidence to suggest that financial pressures created by either low profits or market competition resulted in hospitals engaging in cost-shifting. The authors conclude that health care reforms or market forces that put financial pressures on hospitals can result in cost-containment and improved efficiency without significant cost-shifting.
作者利用美国医院协会和医疗保险计划的数据，分析了1987年至1989年间1435家急症医院在财务压力和市场竞争对多项绩效指标变化的影响。在观察期内，利润最低的医院通过限制员工数量和总资产的增长，将总费用的增长限制在利润最高医院的一半（分别为13.3%和27.6%）。与利润最高组效率略有上升相比，这些变化使效率降低了1.8%（降至11.2%）。同样，与竞争最不激烈地区的医院相比，处于高度竞争市场的医院控制了费用。然而，它们的收入增长也比竞争不那么激烈的医院慢，因此，相对而言，它们的利润率下降了。作者没有发现证据表明低利润或市场竞争造成的财务压力会导致医院进行成本转嫁。作者得出结论，给医院带来财务压力的医疗改革或市场力量可以在不进行重大成本转嫁的情况下实现成本控制和效率提高。
