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The economic behavior of for-profit and nonprofit hospitals: The impact of ownership on responses to changing reimbursement and market environments.

机译：营利性和非营利性医院的经济行为：所有权对对报销和市场环境变化的反应的影响。

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摘要

Among US hospitals, the nonprofit form is the norm, the for-profit form the exception. Economic theory generally predicts greater efficiency and different services in for-profit institutions, but prior research has found few differences between similarly situated for-profit and nonprofit hospitals. This dissertation presents a framework for identifying when nonprofit and for-profit hospital behavior might be similar or diverge and examines the behavior of for-profit and nonprofit hospitals during the 1980s, as the reimbursement and market environment for hospitals became more challenging.;I find that environmental and market factors substantially constrain the freedom of action of nonprofit and for-profit hospitals. Differences appear to be greatest in entry and exit decisions and pricing, areas in which hospital management has the most independence.;The first analysis looks at the reorganization of for-profit hospital chains in California and Florida and assesses whether the economic efficiency or market served by hospitals retained by the chains differs from those divested by the chain, either in the base period or over time. It concludes that the main response of large-chain for-profits to reimbursement pressures has been reorganization and finds no evidence of visible gains in performance.;The second analysis examines pricing by nonprofits and for-profits and cost-shifting in response to uncompensated care. It finds that base pricing by for-profit hospitals is higher than that of nonprofits, and that nonprofits, but not for-profits, increase prices in response to higher uncompensated care. The ability of for-profits to obtain high prices and of nonprofits to cost shift both appear to decline between 1986 and 1990.;The third analysis examines differences in the services offered by nonprofit and for-profit hospitals. It finds few differences among the services offered by nonprofit and for-profit hospitals once controls are introduced for size, location and teaching status. This is generally true even for services identified by hospital administrators as unprofitable, although the differences appear greatest for these services.
机译：在美国医院中，非营利性形式是规范，营利性形式是例外。经济学理论通常预测营利性机构将提高效率并提供不同的服务，但是先前的研究发现，类似位置的营利性医院和非营利性医院之间几乎没有区别。本文提出了一个框架来确定何时非营利性和非营利性医院的行为可能是相似或相异的，并研究了1980年代，随着医院的报销和市场环境变得更具挑战性，营利性和非营利性医院的行为。环境和市场因素严重限制了非营利性和营利性医院的行动自由。在出入境决策和定价方面，医院管理最独立的领域似乎存在最大差异。第一项分析着眼于加利福尼亚和佛罗里达州营利性医院链的重组，并评估了经济效率或市场是否服务在基期或一段时间内，由连锁店保留的医院与连锁店剥离的医院有所不同。结论是，大型连锁营利性组织对报销压力的主要反应是重组，没有发现明显的绩效提升证据;第二种分析考察了非营利性组织和营利性组织的定价以及为应对无偿照护而进行的成本转移。研究发现，营利性医院的基本定价高于非营利性医院，而非营利性组织而非营利性组织会提高价格，以应对更高的无偿医疗服务。在1986年至1990年之间，营利性组织获得高价的能力和非营利性组织转移成本的能力似乎都在下降。第三项分析考察了非营利性和营利性医院所提供服务的差异。一旦引入了规模，位置和教学状态的控制措施，它发现非营利性和营利性医院所提供的服务之间几乎没有差异。即使对于医院管理员认定为无利可图的服务，通常也是如此，尽管这些服务之间的差异似乎最大。

著录项

  • 作者

    Needleman, Jack.;

  • 作者单位

    Harvard University.;

  • 授予单位 Harvard University.;
  • 学科 Economics.;Public health.;Health care management.
  • 学位 Ph.D.
  • 年度 1995
  • 页码 224 p.
  • 总页数 224
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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