보건행정학회지 (Health Policy and Management)

  • 제14권2호
  • /
  • Pages.1-16
  • /
  • 2004
  • /
  • 1225-4266(pISSN)
  • /
  • 2289-0149(eISSN)
한국보건행정학회 (Korean Academy of Health Policy and Management)
권호 표지
DOI QR코드

DOI QR Code

미국 병원의 네트워크 유형 선택에 영향을 미치는 요인분석

Factors Influencing to Select Types of U.S. Hospital Network

  • 김양균 (경희대학교 경영대학 의료경영학과)
  • 발행 : 2004.06.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

The study purpose was to find which factors affect selection of hospital network types. This study used the 1998 American Hospital Association Annual Survey Database from Health Forum. Among these U.S. hospitals, the researcher selected hospitals located in Metropolitan Statistical Areas. Therefore the final observation cases for analysis are 1,971 Metropolitan Statistical Area hospitals in the United States. To identify significant variables influencing hospital network types, the study used proportional odds logistics regression model on population size, Health Maintenance Organization penetration rate, and market competition rate of area including a hospital, types of hospital ownership, hospital bed size, proportion of Medicare patients and Medicaid patients in total hospital patients, and occupancy rate. Contrary to conventional wisdom, selection of hospital network types was influenced by population size of area which a hospital located, types of ownership, hospital bed size, and proportion of medicare patients rather than Health Maintenance Organization penetration. Population size 1,000,000-2,499,999 had the highest probability of selecting type IV (clinical-vertical integration) from an independent hospital, and a religious group owned hospitals and for-profit owned hospitals had the highest probability of selecting Type IV (clinical-vertical integration) from an independent hospital. A bed size had positive relation on selecting Type IV (clinical-vertical integration) from an independent hospital. Unlikely general belief that the selecting types of hospital network was determined by the change of health insurance policy such as Health Maintenance Organizations and Preferred Provider Organizations, the types of hospital network were influenced by community characteristics such as population size, and hospital characteristics.

키워드

참고문헌

  1. Alexander JA, Burns LR, Zucherman HS, Vaughn T, Andersen RM, Torrens P, et al. An exploratory analysis of market-based, physician-organization arrangements. Hospital and Health Services Administration 1996;41(3):311-329.
  2. Alexander JA, Morrisey MA. Hospital-physician integration and hospital costs. Inquiry 1988;25(Fall):388-401.
  3. Alexander JA, Morrisey MA, Burns LR, Johnson V. Physician and clinical integration among rural hospitals. The Journal of Rural Health 1998;14(4):312-26. https://doi.org/10.1111/j.1748-0361.1998.tb00637.x
  4. Alexander JA, Vaughn T, Zucherman HS, Burns LR, Andersen RM, Torrens P, et al. Organizational approaches to integrated health care delivery: a taxonomic analysis of physician organization arragements. Medical Care Research and Review 1996;53(1):70-93.
  5. Bazzoli GJ, Shortell SM, Dubbs N, Chan C, Kralovec P. A taxonomy of health networks and systems: bringing order out of chaos. HSR 1998;33(6):1683-1717.
  6. Brown M, McCool BP. Vertical integration: exploration of a popular strategic concept. Health Care Management Review 1986;11(3):7-20. https://doi.org/10.1097/00004010-198601130-00002
  7. Burns LR, Bazzoli GJ, Dynan L, Wholey DR. Managed care, market stages, and integrated delivery systems: is there a relationship. Health Affairs 1997;14(6):204-18.
  8. Burns LR, Bazzoli GJ, Dynan L, Wholey DR. Impact of HMO market structure on physician-hospital strategic alliances. HSR 2000;35(1):101-32.
  9. Burns LR, Morrisey MA, Alexander JA, Johnson V. Managed care and processes to integrate physicians/hospitals. Health Care Management Review 1998;23(4):70-80. https://doi.org/10.1097/00004010-199810000-00006
  10. Burns LR, Thrope DP. Trends and models in physician-hospital organization. Health Care Management Review 1993;18(4):7-20. https://doi.org/10.1097/00004010-199301840-00002
  11. Burns LR, Thorpe DP. "Managed care and integrated health care," in Health care management: managed care principles and practice, ed H. Jolt, and M. Leibovici. Philadelphia: Handley and Belfus, 1995.
  12. Clement JP, McCue MJ, Luke RD, Bramble JD, Rossiter LF, Ozcan YA, et al. Strategic hospital alliances: impact on financial performance. Health Affairs 1997;16(6):193-203. https://doi.org/10.1377/hlthaff.16.6.193
  13. Connor RA, Feldman RD, Down BE, Radcliff TA. 1997 which types of hospital mergers save consumers money?. Health Affairs 1997;16(6):62-74. https://doi.org/10.1377/hlthaff.16.6.62
  14. Conrad DA, Dowling WL. Vertical integration in health services: theory and managerial Implication. Health Care Management Review 1990;14(4):9-22. https://doi.org/10.1097/00004010-198923000-00003
  15. Dowling W. Strategic alliances as a structure for integrated delivery systems. In partners for the dance: forming strategic alliances, edited by A Kaluzny, H Zucherman, and T Ricketts. Ann Arbor, Mich:Health Administration Press;1995.
  16. Fennell ML, Alexander JA. Perspectives on organizational change in the U.S. Medical Care sector. Annual Review of Sociology 1993;19:89-112. https://doi.org/10.1146/annurev.so.19.080193.000513
  17. Flood AB, Fennell ML. Through the Lenses of Organizational Sociology: The role of organizational theory in conceptualizing and examining our health care system. Journal of Health and Social Behavior 1995;Extra Issue:154-69.
  18. Gillies RR, Shortell SM, Anderson DA, Mitchell JB, Morgan KL. Conceptualizing and measuring integration: findings from the health dystems integration study. Hospital & Health Services Administration 1993;38(4):467-89.
  19. Hill JE, Wild J. Survey provides data on practice acquisition activity. Health Care Financial Management 1995:49(3):54-72.
  20. Kaluzny AD, Zucherman HS, Rabiner DJ. Interorganizational factors affecting the delivery of primary care to older Americans. Health Services Research 1998;33(2):381-401.
  21. Kimberly JR, Zajac EJ. Strategic adaptation in health care organizations: implications for theory and research. Medical Care Review 1985;42:267-302. https://doi.org/10.1177/107755878504200204
  22. Longest BB Jr, Rakich JS, Krut Darr. Managing health services organizations and system. 4th ed. Baltimore(MD): Health Professional Press; 2000. pp.223-267.
  23. McCullagh P, Nelder JA. Generalized linear models, 2d edition. New York: Chapman Hall. 1989
  24. Meliones J. Saving money, saving lives. Harvard Business Review 2000;78(6):57-70.
  25. Miller RH. Health system integration: a means to an end. Health Affairs 1996;15(2):92-106. https://doi.org/10.1377/hlthaff.15.2.92
  26. Morrisey MA, Alexander JA, Burns LR, Johnson V. The effects of managed care on physician and clinical intergration in hospitals. Medical Care 1999;37(4): 350-361. https://doi.org/10.1097/00005650-199904000-00005
  27. Morrisey MA, Alexander JA, Ohsfeldt RL. Physician integration strategies and hospital output. Comparison of rural and urban institutions. Medical Care 1990;28(7): 586-603. https://doi.org/10.1097/00005650-199007000-00005
  28. Pallarito K. Doc Practice Buys are Risky-Moddy's. Modern Health Care 1995;25(11):16.
  29. Schendel DE, Hofer CW. Strategic management: a new view of business policy and planning. Boston, Mass: Little, Brown;1979.
  30. Shortell SM, Gillies RR, Anderson DA. New world of managed care: creating organized delivery systems. Health Affairs 1994;13:46-64. https://doi.org/10.1377/hlthaff.13.5.46
  31. Shortell SM, Gillies RR, Anderson DA, Erickson KM, Mitchell JB. Remarking health care in America. San Francisco (CA): Jossey-Bass;1996.
  32. Shortell SM, Zajac EJ. Health care organizations and the development of the strategic management perspective. In: Mick SS and Assocites. Innovations in Health Care Delivery: Insights for organization Theory. Ann Arbor, Mich: Health Administration Press;1990 pp. 144-180.
  33. Stevens R. American Medicine and the public interest. NEw Haven, CT: Yale University Press;1971.
  34. Van Horn RL, Burns LR, Wholey DR. The impact of physician involvement in managed care on efficient use of hospital resources. Medical Care 1997;35(9):873-889. https://doi.org/10.1097/00005650-199709000-00001
  35. Wall Street Journal. Hospitals that gobbled up physician practices feel ill. June 17, 1997: B4