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医院并购后的医疗质量变化
Changes in Quality of Care after Hospital Mergers and Acquisitions


Nancy D. Beaulieu ... 其他 • 2020.01.02

摘要


背景

医院产业在过去20年间大量整合,而且2010年之后整合速度还在不断加快。多项研究表明,医院合并导致商业保险患者的医疗费用上涨,但关于医疗质量所受影响的研究有限。

 

方法

我们利用2007—2016年的美国老年医疗保险(Medicare)理赔数据和医院比较(Hospital Compare)数据(关于4项医疗质量指标[临床流程综合指标、患者体验综合指标、死亡率和出院后的再住院率]绩效)以及2009—2013年的医院并购数据进行了双重差分分析,比较了被收购医院在收购前后的绩效变化和所有权不变的对照医院的同期绩效变化。

 

结果

研究样本包括246家被收购医院和1,986家对照医院。在患者体验指标绩效方面,被收购与医疗质量的小幅差分下降相关(校正后的差分变化,-0.17 SD;95%置信区间[CI],-0.26~-0.07;P=0.002;这一变化类似于从第50百分位数下降至第41百分位数),而在30日再住院率(-0.10个百分点;95% CI,-0.53~0.34;P=0.72)和30日死亡率(-0.03个百分点;95% CI,-0.20~0.14;P=0.72)方面无显著的差分变化。在临床流程指标绩效方面,被收购医院有显著的差分改善(0.22 SD;95% CI,0.05~0.38;P=0.03),但这不能明确归因于所有权的变化,因为差分改善出现在被收购之前。

 

结论

一家医院被另一家医院或医院系统收购与患者体验略微变差相关,而再住院率或死亡率无显著变化。医疗质量的临床流程指标所受的影响无定论(由美国医疗保健研究与质量局[Agency for Healthcare Research and Quality]资助)。





作者信息

Nancy D. Beaulieu, Ph.D., Leemore S. Dafny, Ph.D., Bruce E. Landon, M.D., M.B.A., Jesse B. Dalton, M.A., Ifedayo Kuye, M.D., M.B.A., and J. Michael McWilliams, M.D., Ph.D.
From the Department of Health Care Policy, Harvard Medical School (N.D.B., B.E.L., J.B.D., J.M.M.), Harvard Business School and the National Bureau of Economic Research (L.S.D.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center (B.E.L.), and the Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital (I.K., J.M.M.) — all in Boston. Address reprint requests to Dr. McWilliams at the Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115, or at mcwilliams@hcp.med.harvard.edu.

 

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