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竞争、质量与整合医疗

Competition, quality and integrated health care
Journal of Health Economics · 2024 · Brekke, Kurt R.、Siciliani, Luigi、Straume, Odd Rune

中文摘要

一些国家推动了医疗服务整合,以改善医疗服务的质量与协调性。我们在一个医疗服务提供者在受规制价格下通过质量竞争吸引患者的模型中,考察此类整合的效应。我们识别出整合对医疗质量产生的相互抵消的效应:一方面,由于捆绑支付,整合使诊疗协调对提供者更有利可图;另一方面,由于患者选择受到限制,整合也削弱了竞争。我们还识别出因提供者之间和/或服务之间的不对称而产生的若干情形,在这些情形下,整合既可能提高也可能降低所提供服务的质量。在不存在协同效应的情况下,整合通常导致某些服务的质量提高,而另一些服务的质量下降。其对健康收益的相应影响,在很大程度上取决于整合是导致各服务间质量的分化还是趋同。如果竞争削弱效应较弱,整合有可能改善医疗质量与患者结局。

Abstract

Integration of health care services has been promoted in several countries to improve the quality and coordination of care. We investigate the effects of such integration in a model where providers compete on quality to attract patients under regulated prices. We identify countervailing effects of integration on quality of care. While integration makes coordination of care more profitable for providers due to bundled payments, it also softens competition as patient choice is restricted. We also identify circumstances due to asymmetries across providers and/or services under which integration either increases or reduces the quality of services provided. In the absence of synergies, integration generally leads to increases in quality for some services and reductions for others. The corresponding effect on health benefits depends largely on whether integration leads to quality dispersion or convergence across services. If the softening of competition effect is weak, integration is likely to improve quality and patient outcomes.
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