Changing Face of American Health Care: Multihospital Systems, Emergency Centers and Surgery Centers

摘要

The paper examines the growth performance of three non-traditional organizations: multihospital systems, freestanding emergency centers and freestanding ambulatory centers. Measures of performance include cost of care, access to care and quality of care. Cost in freestanding ambulatory centers and emergency centers appear to be lower than in traditional hospital settings. During an era of cost-based reimbursement, multihospital systems increased the cost of care. Freestanding emergency and surgery centers tend to treat younger, healthy, middle-class patients and few Medicaid or uninsured patients. System hospitals treat similar percentages of Medicare and Medicaid patients as matched, independent non-profit hospitals. Diagnosis-specific outcomes in freestanding surgery centers appear impressive, but do not adjust for severity of illness of patient characteristics. Based on structural measures of quality of care there was no difference between system and independent hospitals. (Copyright (c) J. B. Lippincott Company, 1985.)