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What drives different treatment choices? Investigation of hospital ownership, system membership and competition.
Health Economics Review ( IF 2.118 ) Pub Date : 2021-02-16 , DOI: 10.1186/s13561-021-00305-3
Esra Eren Bayindir,Jonas Schreyögg

BACKGROUND Differences in ownership types have attracted considerable interest because of policy implications. Moreover, competition in hospital markets is promoted to reduce health care spending. However, the effects of system membership and competition on treatment choices of hospitals have not been considered in studying hospital ownership types. We examine the treatment choices of hospitals considering ownership types (not-for-profit, for-profit, and government), system membership, patient insurance status (insured, and uninsured) and hospital competition in the United States. METHODS We estimate the probability of according the procedure as the treatment employing logistic regression. We consider all procedures accorded at hospitals, controlling for procedure type and diagnosis as well as relevant patient and hospital characteristics. Competition faced by hospitals is measured using a distance-weighted approach separately for procedural groups. Patient records are obtained from State Inpatient Databases for 11 states and hospital characteristics come from American Hospital Association Annual Survey. RESULTS Not-for-profit hospitals facing low for-profit competition that are nonmembers of hospital systems, act like government hospitals, whereas not-for-profits facing high for-profit competition and system member not-for-profits facing low for-profit competition are not statistically significantly different from their for-profit counterparts in terms of treatment choices. Uninsured patients are on average 7% less likely to be accorded the procedure as the treatment at system member not-for-profit hospitals facing high for-profit competition than insured patients. System member not-for-profit hospitals, which account for over half of the observations in the analysis, are on average 16% more likely to accord the procedure as the treatment when facing high for-profit competition than low-for-profit competition. CONCLUSIONS We show that treatment choices of hospitals differ by system membership and the level of for-profit competition faced by the hospitals in addition to hospital ownership type and health insurance status of patients. Our results support that hospital system member not-for-profits and not-for-profits facing high for-profit competition are for-profits in disguise. Therefore, system membership is an important characteristic to consider in addition to market competitiveness when tax exemption of not-for-profits are revisited. Moreover, higher competition may lead to increasing health care costs due to more aggressive treatment choices, which should be taken into account while regulating hospital markets.

中文翻译:

是什么促使不同的治疗选择?调查医院所有权,系统成员资格和竞争。

背景技术由于政策的影响,所有权类型的差异引起了人们的极大兴趣。此外,促进了医院市场的竞争以减少医疗保健支出。但是,在研究医院所有权类型时,并未考虑系统成员资格和竞争对医院治疗选择的影响。我们根据美国的所有权类型(非营利性,营利性和政府性),系统成员资格,患者保险状态(有保险和无保险)和医院竞争情况,检查了医院的治疗选择。方法我们估计采用Logistic回归进行治疗的可能性。我们考虑所有符合医院的程序,控制程序类型和诊断以及相关的患者和医院特征。医院所面临的竞争是使用距离加权方法分别针对程序组进行衡量的。病人记录来自11个州的州住院病人数据库,医院特征来自美国医院协会年度调查。结果非营利性医院面临的非营利性竞争是医院系统的非成员,其行为类似于政府医院,而非营利性医院则面临着高营利性竞争,而系统成员的非营利性组织则面临着非营利性低下就治疗选择而言,竞争与营利性竞争对手在统计学上没有显着差异。没有保险的患者与接受保险的患者相比,在面临高利润的竞争的系统成员非牟利医院接受治疗的可能性平均降低了7%。系统成员非营利性医院占分析中观察值的一半以上,面对高额营利性竞争时比采用非营利性竞争平均高出16%接受该程序作为治疗的可能性。结论我们表明,除了医院所有权类型和患者的健康保险状况外,医院的治疗选择还取决于系统成员资格和医院所面临的营利性竞争水平。我们的结果支持医院系统成员非营利组织和面临高额营利性竞争的非营利组织是变相的营利组织。因此,在重新审查非营利组织的免税政策时,除市场竞争力外,系统成员资格也是要考虑的重要特征。而且,
更新日期:2021-02-16
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