企业边界理论对医院规模的启示与思考

应用交易费用、规模经济和范围经济理论.对医院横向和纵向边界的选择作初步探讨.指出横向和纵向边界是医院规模的两种经济学属性,规模边界的选择与医院自身生产能力和所在医疗市场有关,规模不是静态的,而是逐步优化的动态过程.     

医院规模的理论分析

应用交易费用、规模经济和范围经济理论,对医院横向和纵向边界的选择做初步探讨。指出,横向和纵向边界是医院规模的丽种经济学属性,规模边界的选择与医院自身生产能力和所在医疗市场有关,规模不是静态的,而是逐步优化的动态过程。     

医院发展有没有边界

<正>过去医院的边界基本上是静态的,只考虑人口经济发展的水平,现在医院的边界应该是动态。现在中国的医院建设发生了很多变化。如今,公立医院借助社会资本成为一大热点话题,希望通过这种方式来突破公立医院的边界。那么,医院发展有没有边界?目前,我国医院不管是公立医院还是民营医院,在过去的10年中发展及其迅速,医院大楼越盖越高,医护人员的数量成倍增长。2009年以前,国家对于医疗行业投入的资金比例越来越少。     

重塑组织边界:深圳医务社会工作的经验与反思

医务社会工作是医院与社会工作机构跨越组织边界的合作。通过对深圳医务社会工作的调查分析,揭示了医院与社会工作机构之间存在制度边界、物理边界、认同边界,具体表现为业务流程与管理规范的隔离、服务空间与信息流通的壁垒、主体间的认同困境,阻碍了医务社会工作的开展。医院主动开放边界的举措与社会工作机构主动渗透的策略促进了组织合作,重塑了组织边界,但也存在一定的不足。     

基于企业边界理论的医药分开思考

目的:分析医药分开的影响因素,探索医药分开的改革措施。方法:借鉴企业边界理论研究医院与药房的关系。结果:目前我国医药不分的主要因素是处方的捆绑式销售和大型集中式门诊。结论:通过改革医疗保险制度,促进处方流动以降低医院药房的收入,同时采取征收营业税等手段增加医院药房的运营成本,促进医院放弃药房,最终实现医药分开。     

基于边界分析的民营医院发展问题的探析和启示

采用文献边界分析,形成问题系统并进行边界分析。基于问题视角,指出解决问题的思路包括需完善政府和民营医院对其发展定位和管理,重塑医院品牌等。基于研究视角,指出民营医院的研究需与实践紧密配合,考虑研究设计的合理性和策略措施的可操作性等。     

基于整合的医院战略性外包及实践

医院外包能够有效节约成本,并能利用外包承接方的专业技术改善服务质量,但目前尚没有医院业务外包的标准方案。企业边界理论以及外包业务选择模型阐述业务外包的可能性与可行性,SWOT分析以及外包误区告诉管理者,良好的沟通与监管机制才能发挥外包优势。     

太原市城区铁路边界噪声污染状况调查

[目的]了解太原市城区范围内铁路边界噪声的污染状况。[方法]按照GB 12525-90《铁路边界噪声限值及其测量方法》对城区和铁路边界进行噪声监测。[结果]噪声敏感点以铁路住宅区为主,这些住宅区均与铁路边界重合;列车在各敏感点区段均须鸣笛,未采取噪声控制措施;各监测点的昼、夜间噪声值,作为铁路边界噪声合标率达90.91%,作为环境噪声其合标率为0%。[结论]太原市城区范围内铁路边界噪声作为噪声源合标率很高,但对与铁路边界重合的敏感点的环境噪声污染很严重。     

医改要打通边界内外协同

作为一个地市卫生局长，除了要有相关的知识、能力之外，更重要的是需要智慧。卫生事业发展面临着内部的水平边界、垂直边界，还有外部的行业边界，只有对内加强沟通，     

肺癌精确放疗中PTV外扩边界的研究进展

介绍了PTV外扩边界的相关定义和计算方法。重点论述了呼吸运动和摆位误差对PTV外扩边界的重要影响,以及通过探索肺癌肿块在呼吸运动过程中的位移规律,建立预测数学模型计算PTV外扩边界的研究进展。指示了采取呼吸控制、精确摆位等技术对减小靶区外扩边界的作用。     

Investigating hospital efficiency in the new NHS: The role of the translog cost function

The reforms to the United Kingdom's National Health Service (NHS) of recent years have greatly increased the role of economic incentives in the hospital sector. Hospitals now have to compete for the business of GP and health authority purchasers and are assumed to have an incentive to minimise costs. This makes the analysis of cost functions much more relevant than has previously been the case. The objective of this paper is to assess the potential usefulness of the translog cost function applied in the NHS internal market. Three main issues are identified that limit the role of this type of cost function in the internal market: the adequacy of the econometric model (including data quality); the assumptions underlying the model, and; the interpretation of economies of scale, marginal costs and economies of scope that can be derived from such a cost function. It is concluded that at present the application of translog cost function analysis in the NHS is of limited usefulness, but that it does indicate areas for further methodological research.     

Concentrating Emergency Rooms: Penny‐Wise and Pound‐Foolish? An Empirical Research on Scale Economies and Chain Economies in Emergency Rooms in Dutch Hospitals

In this paper, we address the issue of whether it is economically advantageous to concentrate emergency rooms (ERs) in large hospitals. Besides identifying economies of scale of ERs, we also focus on chain economies. The latter term refers to the effects on a hospital's costs of ER patients who also need follow‐up inpatient or outpatient hospital care. We show that, for each service examined, product‐specific economies of scale prevail indicating that it would be beneficial for hospitals to increase ER services. However, this seems to be inconsistent with the overall diseconomies of scale for the hospital as a whole. This intuitively contradictory result is indicated as the economies of scale paradox. This scale paradox also explains why, in general, hospitals are too large. There are internal (departmental) pressures to expand certain services, such as ER, in order to benefit from the product‐specific economies of scale. However, the financial burden of this expansion is borne by the hospital as a whole. The policy implications of the results are that concentrating ERs seems to be advantageous from a product‐specific perspective, but is far less advantageous from the hospital perspective. © 2016 The Authors. Health Economics Published by John Wiley & Sons, Ltd.     

Potential effects of managed competition in rural areas

This article assesses the extent to which managed competition could be successful in rural areas. Using 1990 Medicare hospital patient origin data, over 8 million rural residents were found to live in areas potentially without provider choice. Almost all of these areas were served by providers who compete for other segments of their market. Restricting use of out-of-State providers would severely limit opportunities for choice. These findings suggest that most residents of rural States would receive cost benefits from a managed competition system if purchasing alliances are carefully defined, but consideration should be given to boundary issues when forming alliances.     

Home care and the reshaping of acute hospitals in England. An overview of problems and possibilities

A changing boundary between hospital and home-care services over two decades has taken place enabling people to live in their own homes wherever possible, enabling "choice of independence". Against this background, five principal issues are raised regarding how hospital services have been reshaped over that time and how the pattern of service developments outside the hospital has altered over the same period.     

医院成本核算与成本控制的应用与分析

论述了医院成本核算的必要性和现实性，阐明了医疗成本的经济实质和实现内容。重点分析了医院成本核算的种类和定位、医院成本核算方法的选择、医院成本核算流程及分摊方法。     

The impact of physician characteristics in conditional choice models for hospital care

Recent research has investigated the determinants of the specific hospitals to which patients are admitted. Data limitations have led researchers to examine the effects of patient and hospital characteristics while ignoring the role of physician characteristics. In this study we analyze the effects of all three sets of factors on hospital choice in the greater Phoenix area during 1989. Our results suggest that physician characteristics are strong determinants of hospital choice, accounting for much of the explained variation. Differences in hospital quality and cost, on the other hand, exert significant effects on hospital choice but explain relatively little variation.     

中国县级公立医院医保支付方式改革与医院控费策略研究

目的：分析六省部分县级公立医院医保支付方式与医院控费策略的实施情况,探讨医保支付方式与医院控费策略选择之间的相关性,为改进医保支付方式,优化医院控费策略提供建议。方法：采用问卷调查的方式收集并描述样本医院医保支付方式和医院控费策略情况,采用Stata 14.0软件进行数据统计和分析,探究二者之间相关性。结果：按项目付费、总额预付和按病种付费是最主要的支付方式。样本医院采取的控费策略主要有费用控制策略、限制供应策略、质量管理策略等,且其中更多的医院选择了质量管理策略,不同支付方式下的控费策略选择具有显著性差异。结论：医保支付方式和医院控费策略选择之间存在相关性,建议在制定支付方式相关政策时,配套合理医院控费策略降低医院费用超支风险。     

Scale and scope economies in nursing homes: a quantile regression approach

Nursing homes vary widely between facilities with very few beds and facilities with several hundred beds. Previous studies, which estimate nursing home scale and scope economies, do not account for this heterogeneity and implicitly assume that all nursing homes face the same cost structure. To account for heterogeneity, this paper uses quantile regression to estimate cost functions for skilled and intermediate care nursing homes. The results show that the parameters of nursing home cost functions vary significantly by output mix and across the cost distribution. Estimates show that product-specific scale economies systematically increase across the cost distribution for both skilled and intermediate care facilities, with diseconomies of scale in the lower deciles and no significant scale economies in the higher deciles. As for ray scale economies, estimates show economies of scale in the lower deciles and diseconomies of scale or no significant scale economies at higher deciles. The estimates also show that scope economies exist in the lower cost deciles and that no scope economies exist in the higher cost deciles. Additionally, the degree of scope economies monotonically decreases across the deciles.     

Hospital Health Care: Pricing and Quality Control in a Spatial Model with Asymmetry of Information

The cost of hospital care depends on the quality of the service, on the personal characteristics of the patient, on the effort of the medical staff and on information asymmetry. In this article the cost minimizing properties of alternative payment systems will be discussed in a context where hospitals can observe patient severity and compete according to the rules of Hotelling's spatial competition. The scheme is designed from the standpoint of a purchaser that sets up a contract with several providers for services of a given quality at the least possible cost. Patients' severity cannot be observed and quality cannot be verified, but the latter can be inferred through the choice of patients. The model shows that in the health care market, prospective payments and yardstick competition are weak instruments for cost containment; incentive compatible schemes are, at least from a theoretical point of view, better instruments especially in a context where the purchaser can use signals relating to the variables it cannot observe. Cost inflation has two components: the information rent paid to the provider and inefficiency. In our model the information rent is used by the provider to get more patients to his hospital; spatial competition can then be used to curb the cost of providing hospital care. JEL classification: I110, I180, D820