Okasha AA.
AHSR FHSR Annu Meet Abstr Book. 1996; 13: 192.
Williamson Institute, Medical College of Virginia, Richmond 23298, USA.
RESEARCH OBJECTIVES: The purpose of this research was to investigate the effect of market structure factors, buyers-of-care-related factors, and organizational factors on hospital differentiation and product line specialization, and also to examine the relationship between hospital product differentiation and specialization. STUDY POPULATION: The study examined all Medicare claims data for the years 1987 and 1993, to construct the measure of hospital specialization for each study hospital. The study hospitals are acute care. STUDY DESIGN: This paper investigates hospital specialization, with the hospital as the unit of analysis. A trend design was used to examine the relationships of interest. Data pertaining to the hospitals operating in 1987 and 1993 were collected and examined for interrelationships. The change in the differentiation indicator between 1987 and 1993 for all hospitals was tested against its proposed determinants in 1993. Likewise, the positive change in the specialization indicator between 1987 and 1993 was tested against its determinants in 1993. To test the relationship between hospital differentiation and specialization, the relationship between the change in the differentiation measure based on the percentage of board-certified physicians and the change in the specialization index, between 1987 and 1993, was tested. PRINCIPAL FINDINGS: This research documents the statistically significant rise in hospital specialization and differentiation for the period of 1987-1993. This study expands the understanding of the process of hospital product differentiation and specialization, as the findings from the path analysis show a statistically significant positive relationship between the two concepts. For hospital differentiation, results from the multivariate analyses show that competition, buyers' pressures, and organizational size are the significant factors explaining the change in differentiation. For hospital specialization, results from the multivariate analyses show that buyer-related factors and organizational factors are the most important predictors of the positive change in hospital specialization between 1987 and 1993. High competition, the increased pressure from buyers of care, and organizational size are statistically significant predictors of the positive change in the hospital specialization measures between 1987 and 1993. CONCLUSION AND IMPLICATIONS: The study explores the relationship between the hospital product line differentiation and specialization, and found that the long-anticipated effect of buyers of care on hospital specialization is finally arriving. Buyer-related factors and organizational factors are the most important predictors of the positive change in hospital differentiation and specialization between 1987-1993. The results of this study have the following implications: (1) if specialization is not occurring, policy makers may want to reconsider regulation, or encourage selective contracting with hospitals to force specialization in the market; and (2) the results of this study increases the relevance of those studies examining the relationships between specialization and efficiency, improving the quality of patient care, and increasing profits.
Publication Types:
Keywords:
- Economic Competition
- Hospitals
- Humans
- Regression Analysis
- Research Design
- economics
- hsrmtgs
Other ID:
UI: 102222414
From Meeting Abstracts