보건행정학회지 (Health Policy and Management)

  • 제18권1호
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  • Pages.1-20
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  • 2008
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  • 1225-4266(pISSN)
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  • 2289-0149(eISSN)
한국보건행정학회 (Korean Academy of Health Policy and Management)
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병원시장의 경쟁특성과 병원행태

Competition in the Hospital Service Market and Its Impact on Hospital Behavior in Korea

  • 발행 : 2008.03.31
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초록

How health care providers compete and how competition among them affects their behavior are crucial questions in theory and health policy. In ordinary markets, competition improves social welfare, However in health care markets facing uncertainty and information asymmetry, competition can take the form of wasteful quality competition and result in cost increase. The purpose of this study is to examine the characteristics of hospital service markets and examine the impact of hospital competition on hospital behavior, more specifically hospital cost and the size of personnel. Based on patient discharge data of 2002 by the Ministry of Health and Welfare and Korea Institute for Health and Social Affairs, and health insurance EDI claims data of 2002, this study measures the degree of competition in the inpatient service market of hospitals, using variable radius method and Herfindahl index. The result of the study shows that the hospital service market consists of on average 3.13 government administrative units(shi, gun, or gu). Compared with hospitals, general or general specialized hospitals cover larger markets and operate in more competitive markets. Nearly 60% of patients use hospitals, which are not located in their government administrative units, meaning that market definition based on variable radius is better than the conventional method of market definition based on government administrative units. The results of multivariate analysis show that competition is not associated with high cost index of hospitals. But hospitals in more competitive markets employ larger(more intensive) input of personnel per 100 beds, implying that hospital competition in Korea can have the form of quality and cost-increasing competition.

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참고문헌

  1. 강길원, 박하영, 신영수. 한국형진단명기준환자군의 개선과 평가. 보건행정학회지 2004;14(1): 121-147
  2. 국민건강보험공단. 노인의료비 지출 10년간 8배 증가, 2007. Available from:URL: http://www.nhic.or.kr/cms/board/board/SelectBoardForm.jsp?communityKey=B0005&boardId=4083
  3. 김윤미, 양봉민. 일반외과 영역 다빈도 수술률의 소규모 지역간 변이. 보건행정학회지 2004;14(2):138-162
  4. 보건복지부ᆞ한국보건사회연구원. 2002년도 환자조사보고서. 서울;한국보건사회연구원 정책보고서 2003-82:2003
  5. 신영수, 박하영, 염용권, 이영성. 한국형 진단명 기준 환자군의 개발과 평가. 예방의학회지 1993;26(2):293-309
  6. 이경희, 권순만. 지방공사 의료원의 성과에 영향을 미치는 요인 연구. 보건행정학회지 2004;13(2):102-124
  7. Baker LC. Measuring competition in health care markets. Health Services Research 2001:36(1);223-251
  8. Cotterill PG, Bobula J, Connerton R. Comparison of alternative relative weights for diagnosis-related groups. Health Care Financing Review 1986;7(3):37-51
  9. Dranove D, Shanley M. A note on the relational aspects of hospital market definitions. Journal of Health Economics 1990;8(4);473-478 https://doi.org/10.1016/0167-6296(90)90028-2
  10. Dranove D, Shanley M, Simon C. Is hospital competition wasteful?. Rand Journal of Economics 1992;23(2): 247-261 https://doi.org/10.2307/2555987
  11. Dranove D, Shanley M, White WD. Price and concentration in hospital markets: The switch from patient-driven to payer-driven competition. Journal of Law and Economics 1993;36(1);179-204 https://doi.org/10.1086/467270
  12. Feldman R, Chan HC, Kralewski J, Dowd B, Shapiro J. Effects of HMOs on the creation of competitive markets for hospital services. Journal of Health Economics 1990;9(2):207-222 https://doi.org/10.1016/0167-6296(90)90018-X
  13. Frech H, Competition and monopoly in medical care. Washington(DC):AEI Press;1996
  14. Gresenz CR, Rogowski J, Escarce JJ. Updated variable-radius measures of hospital competition. Health Services Research 2004;39(2):417-430 https://doi.org/10.1111/j.1475-6773.2004.00235.x
  15. Joskow PL. The effects of competition and regulation on hospital bed supply and the reservation quality of the hospital. Bell Journal of Economics 1980;11(2):421-447 https://doi.org/10.2307/3003372
  16. Luft HS, Phibbs CS, Garnick DW, Robinson JC. Rejoinder to Dranove and Shanley. Journal of Health Economics 1990;8(4): 479-483 https://doi.org/10.1016/0167-6296(90)90029-3
  17. Luft HS, Robinson JC, Garnick DW, Maerki SC, McPhee SJ. The role of specialized clinical services in competition among hospitals. Inquiry 1986;23(Spring):83-94 https://doi.org/10.1080/00201748008601892
  18. Lynk WJ. The creation of economic efficiencies in hospital mergers. Journal of Health Economics 1995;14(5):507-530 https://doi.org/10.1016/0167-6296(95)00019-4
  19. Melnick GA, Zwanziger J. Hospital behavior under competition and cost-containment policies. Journal American Medical Association 1988;260(18):2669-2675 https://doi.org/10.1001/jama.260.18.2669
  20. Melnick GA, Zwanziger J, Bamezai A, Pattisonet R. The effects of arket structure and bargaining position on hospital prices. Journal of Health Economics 1992;11(3):217-233 https://doi.org/10.1016/0167-6296(92)90001-H
  21. Noether M. Competition among hospitals. Journal of Health Economics 1988;7(3):259-284 https://doi.org/10.1016/0167-6296(88)90028-8
  22. Pettengill J, Vertrees J. Reliability and validity in hospital case-mix measurement. Health Care Financing Review 1982;4(2):101-128
  23. Rivers PA, Fottler MD. Do HMO penetration and hospital competition impact quality of hospital care?. Health Services Management Research 2004;17(4):237-248 https://doi.org/10.1258/0951484042317741
  24. Robinson JC, Luft HS. The impact of hospital market structure on patient volume, average length of stay, and the cost of care. Journal of Health Economics 1985;4(4):333-356 https://doi.org/10.1016/0167-6296(85)90012-8
  25. Robinson JC, Luft HS. Competition and the cost of hospital care, 1972 to 1982. Journal of American Medical Association 1987;257(2):3241-3245 https://doi.org/10.1001/jama.257.23.3241
  26. Robinson JC and Luft HS. Competition, regulation, and hospital costs, 1982 to 1982. Journal of American Medical Association 1988;260(18):2676-2681 https://doi.org/10.1001/jama.260.18.2676
  27. Scherer FM, Ross D. Industrial market structure and economic performance. 3rd ed. Boston(MA):Houghton Mifflin Company;1990. pp. 52-55
  28. Zwanziger J, Melnick GA. The effects of hospital competition and the medicare PPS program on hospital cost behavior in California. Journal of Health Economics 1988;7(4):301-320 https://doi.org/10.1016/0167-6296(88)90018-5