Ginsburg P B
J Health Polit Policy Law. 1997 Apr;22(2):363-82. doi: 10.1215/03616878-22-2-363.
Health care exhibits a competitive dynamic today that increasingly resembles that in other service industries. Organizations are becoming larger to achieve scale economies and to increase market power. Vertical integration, whether through ownership or complex contracts, is also being pursued both to seek efficiencies and to improve the bargaining position of the organization. External forces that are driving these changes include more aggressive activities on the part of purchasers to contain their costs, developments in information technology, management innovation in other service industries, and advances in medical technology. Within the health care industry, there is a pattern of organizations taking the initiative to respond to these external forces--often in anticipation of them--and other organizations then responding to the pressures in turn placed on them. Although information on strategies is communicated rapidly throughout the country, what is attempted and what succeeds differs a great deal across communities. The nature of current health care institutions in the community, including the presence of large entities with extensive capital and strong management in a particular segment of the health system and the community's experience with managed care are important factors in the path that change takes.
如今，医疗保健呈现出一种竞争态势，越来越类似于其他服务业。各机构规模日益扩大，以实现规模经济并增强市场影响力。无论是通过所有权还是复杂合同进行的纵向整合，也在被推行，目的是提高效率并改善机构的谈判地位。推动这些变革的外部力量包括购买方为控制成本而采取的更积极行动、信息技术的发展、其他服务业的管理创新以及医疗技术的进步。在医疗保健行业内部，存在这样一种模式：一些机构主动应对这些外部力量——往往是在预料到这些力量之前——而其他机构则随后对施加在它们身上的压力做出反应。尽管有关战略的信息在全国范围内传播迅速，但不同社区在尝试的内容和取得成功的方面存在很大差异。社区中当前医疗保健机构的性质，包括在卫生系统的特定领域中存在拥有大量资本和强大管理能力的大型实体，以及社区在管理式医疗方面的经验，都是变革所采取路径中的重要因素。
