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组织边界对医疗协调与医疗利用的影响

The Impact of Organizational Boundaries on Health Care Coordination and Utilization
American Economic Journal: Economic Policy · 2023 · Leila Agha、Keith M. Marzilli Ericson、Xiaoxi Zhao

中文摘要

——患者医疗服务在不同组织间的分布——以此考察企业边界如何影响医疗效率。首先,当患者迁往门诊就诊通常集中于少数几家企业的地区时,其医疗利用会下降。其次,对于初级保健医生(PCP)退出市场的患者,转向组织集中度高出1个标准差的初级保健医生会使医疗利用减少21%。在控制医疗服务在不同提供者间的分散程度后,这一发现依然稳健。组织集中度的提高预示着糖尿病护理的改善,且与急诊或住院服务使用的增加无关。

Abstract

-the distribution of a patient's healthcare across organizations-to examine how firm boundaries affect healthcare efficiency. First, when patients move to regions where outpatient visits are typically concentrated within a small set of firms, their healthcare utilization falls. Second, for patients whose PCPs exit the market, switching to a PCP with 1 standard deviation higher organizational concentration reduces utilization by 21%. This finding is robust to controlling for the spread of healthcare across providers. Increases in organizational concentration predict improvements in diabetes care and are not associated with greater use of emergency department or inpatient care.
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