Hospitals' Strategic Responses to Competitive Markets. Abstract, Executive211 Summary and Final Report

摘要

The studies funded by this grant investigated the effect of increased competition211u001eand HMO penetration on hosptials reource allocation decisions and quality of 211u001ecare. The first focused on hospitals in California, comparing resource allocation 211u001eand RAMR in 1982 and 1989. The second examined RAMR of FFS patients in a national 211u001esample of hospitals in 134 MSAs. The findings suggest that the relationship 211u001ebetween competition and hospitals resource allocations have changed during the 211u001e1982-1989 period, as selective contracting became an important aspect of 211u001ehosptial/payer negotiations. The association the authors find between clinical 211u001eresource use and risk adjusted mortality rates, therefore, raise concerns that 211u001esome of these trends may lead to worse mortality outcomes. The national study 211u001eprovides further support, also finding that hospital competition is associated 211u001ewith poorer outcomes, although these results were not statistically significant.