Hospital service scope expansion and market share improvement: a dynamic modeling and multivariate approach.

In a national trend, large, acute-care hospitals located in urban areas of the nation were continuously broadening their service scope, adding services at the rate of one each year, from 1982 to 1987. This study proposes that the underlying rationale of hospital service-scope expansion is status-gap minimization. This perspective was quantitatively interpreted and tested by a dynamic modeling analysis. Findings support status-gap minimization as the rationale for service-scope expansion. Using multivariate regression and dynamic modeling analysis, the study demonstrates that the cross-sectional relationship between two steady states--the relationship between service scope and market share--is positive and statistically significant. However, the market share change is not related to hospital service scope. The interpretation offered is that hospitals expand the scope of services looking not so much to increase their market share benefit in the short run as to raise their organizational status. In the long run, higher organizational status such as broader service scope then benefits market share.     

Measuring service line competitive position. A systematic methodology for hospitals

To mount a broad effort aimed at improving their competitive position for some service or group of services, hospitals have begun to pursue product line management techniques. A few hospitals have even reorganized completely under the product line framework. The benefits include focusing accountability for operations and results, facilitating coordination between departments and functions, stimulating market segmentation, and promoting rigorous examination of new and existing programs. As part of its strategic planning process, a suburban Baltimore hospital developed a product line management methodology with six basic steps: (1) define the service lines (which they did by grouping all existing diagnosis-related groups into 35 service lines), (2) determine the contribution of each service line to total inpatient volume, (3) determine trends in service line volumes (by comparing data over time), (4) derive a useful comparison group (competing hospitals or groups of hospitals with comparable size, scope of services, payer mix, and financial status), (5) review multiple time frames, and (6) summarize the long- and short-term performance of the hospital's service lines to focus further analysis. This type of systematic and disciplined analysis can become part of a permanent strategic intelligence program. When hospitals have such a program in place, their market research, planning, budgeting, and operations will be tied together in a true management decision support system.     

A clinically based service limitation option for alternative model rural hospitals

Alternative model rural hospitals are designed to address problems faced by small, isolated rural hospitals. Typically, hospital regulations are reduced in exchange for a limit on the services that alternative models may offer. The most common service limitation is a limit on length of stay (LOS), a method with little empirical or conceptual support. The purpose of this article is to present a clinically based service limitation for alternative model rural hospitals, such as the rural primary care hospital. The proposal is based on an analysis of Medicare discharges from rural hospitals most likely to convert and the judgments of a technical advisory panel of rural clinicians.     

市场竞争对医院运行效率的影响——基于跨省份地级市数据的实证研究

目的 基于跨省地级市数据,从市场份额和资源配置考察民营医院参与市场竞争对医院运行效率的促进效应。方法 利用2011—2018年54个地级市的面板数据,采用赫芬达尔—赫希曼指数( Herfindahl－Hirschman Index,简称HHI指数)计算医院市场集中度,采用固定效应面板模型进行实证分析。结果 2011—2018年样本地区医院全要素生产率指数、技术效率变化指数和技术进步指数分别上升了0.04、0.01、0.03。在市场份额中,门急诊诊疗人次、出院人次HHI指数分别下降了0.06和0.10;在资源配置中,执业（助理）医师、实有床位数HHI指数则下降了0.09和0.14。固定效应面板回归分析发现:门急诊诊疗人次HHI对技术效率变化指数、技术进步指数具有显著的正向或负向影响;出院人次HHI对全要素生产率指数、技术效率变化指数和技术进步指数均有显著负向影响;执业（助理）医师HHI对全要素生产率指数、技术效率变化指数和技术进步指数具有显著的正向或负向影响;实有床位HHI对全要素生产率指数、技术进步指数有显著的正向影响。结论 市场竞争对医院运行效率作用机制出现分化:市场份额竞争促进全要素生产率和技术效率改善,抑制技术进步;资源配置竞争则相反。应健全社会办医政策体系,完善社会办医内部管理机制,提高市场竞争层次。     

The WAMI Rural Hospital Project. Part 2: Changes in the availability and utilization of health services.

A major goal of the Rural Hospital Project (RHP) was to assist communities in defining an optimal scope of hospital and community health services. It was hypothesized that a rational basis for service planning would result in an expansion of locally provided health services, increased local hospital and physician market share, improved hospital workload performance, and higher levels of consumer satisfaction with community-based services. However, given the recent decline in performance of many small rural hospitals in general and in RHP hospitals in particular, at a minimum, stabilization of these troubled facilities could be considered a successful outcome. Data were collected from the six rural communities participating in the RHP both before and after the intervention (1985 and 1989) to assess changes in community scope of health services and utilization patterns. Comparative data were also compiled from peer group hospitals when available. Results generally demonstrated stabilization or expansion in: (1) the range of community and hospital services, (2) the availability of community physicians and visiting specialties, and (3) physician and hospital market share. While findings were mixed for patient days, average daily census, and number of births, substantial increases were documented for the number of surgical procedures, emergency room visits, and x-rays over the study period. RHP hospitals generally outperformed peer group hospitals on market share measures.     

论我国公立医院的配置调整思路

不同历史时期,公立医院应当承担起不同的历史责任。在医疗卫生资源稀缺时期,公立医院应当是配置主体。在医疗卫生资源丰富时期,公立医院应当是制衡主体。在民营医院发展到一定规模的时候,公立医院应当专注于向低收入人群提供适宜的医疗卫生服务。这是“市场能做的市场做,市场不能做的政府做”思想的集中体现。我国公立医院在医疗市场中的份额,在今后若干年内可以下降到70％～60％的水平。     

Cardiology needs good planning for the future

In today's health care environment, hospitals have to develop strategies to maintain their market share, especially in cardiac services. The authors share generic strategies in cost leadership, product differentiation and technological leadership that can be adapted and implemented in cardiac centers.     

Competition among hospitals in the United States

The value added by acute-care hospitals is in the form of specific procedures (therapy, operations, testing) and the bed care necessary to make the procedures effective. When more than one hospital exists in a local area (defined in many studies as a radius of 15 mi/24 km) they compete for market share, since greater market share has a positive effect on economies of scale, utilization rates, learning curves and levels of quality. Competition is not only with other hospitals (and 75% of all hospitals do have a competitor within 24 km), but also with doctors who now perform some procedures in their offices, and with specialized clinics. The first strategy is to attract physician allegiance since they act as gate-keepers, directing patients to specific hospitals. This is done through personal amenities, professional amenities and enhancement to personal prestige and income. This competition for physician allegiance has a direct effect on utilization rates (doctors want spare capacity to suit their needs), on the range of services and facilities offered (doctors want more support), and on length of stay (doctors want longer stays). All of these increase the hospital's costs. The second strategy is to enter into contracts with third-party payers who will direct their clients to specific or preferred hospitals. The negative effect is that in competitive markets such payers may be able to bargain prices down. However, hospital differentiation makes it difficult for payers to make complete substitutions among them. As well, since the payers compete for clients, they often use hospital alliances as a selling point and therefore are often cooperative rather than confrontational in their negotiations. One tactic used by hospitals is to stress quality of service. But since quality in health care is hard to measure, patients are often unable to make direct assessments of alternatives. Hospitals therefore often 'signal' quality in various ways which may, and often do, increase hospital costs. (Some of these signals also attract physicians). Price is not a major element in competition. Most other strategies and tactics raise hospital costs and therefore price. Pressure from payers is turned back through differentiation (preventing substitution) and hospital-payer alliances for clients. Health care comes in too many packages to allow effective price competition. A final tactic is to increase the range of services or facilities offered. Enhanced services attract doctors by offering more support; attract some patients direct; and help to recapture market share lost to specialized clinics.(ABSTRACT TRUNCATED AT 400 WORDS)     

Hospital market share: the declining share of small players in the market

Analysis of a set of isolated hospital markets reveals that low-market-share hospitals have experienced a consistent decline in their market share for the last five years. The challenges presented by such a decline in market share are compounded by the overall decline in the total market (in terms of number of hospital discharges) for the markets studied. It is suggested that significant strategy changes may be required if low-market-share hospitals are to survive.     

Estimating hospital service areas using mortality statistics.

This article reports research testing an alternative methodology for patient origin studies that uses hospital deaths as a proxy measure for all discharges from a selected group of urban tertiary hospitals. Results indicated that mortality data from vital statistics records provide a reasonable approximation of patient travel patterns to acute care hospitals. Hospital service area indexes constructed from mortality statistics accurately predicted, on an aggregate regional basis, the results of a conventional patient origin study based on all hospital discharges. Hospital service areas, an important element of locational analysis in health planning, can be identified with the suggested methodology for states and areas lacking statewide uniform hospital discharge systems. A number of caveats are suggested for applying this methodology and interpreting its results.     

Public and private hospitals in Bangladesh: service quality and predictors of hospital choice

This study compares the quality of services provided by publicand private hospitals in Bangladesh. The premise of the paperwas that the quality of hospital services would be contingenton the incentive structure under which these institutions operate.Since private hospitals are not subsidized and depend on incomefrom clients (i.e. market incentives), they would be more motivatedthan public hospitals to provide quality services to patientsto meet their needs more effectively and efficiently. This premisewas supported. Patient perceptions of service quality and keydemographic characteristics were also used to predict choiceof public or private hospitals. The model, based on discriminantanalysis, demonstrated satisfactory predictive power.     

Contract management in USA hospitals: service duplication and access within local markets

This paper examines the extent to which hospitals that are under external contract management engage in service duplication, as well as the degree to which the various services they offer contribute to or detract from community access. The study incorporates all USA hospitals using data from the American Hospital Association Annual Survey Database, supplemented by county level measures obtained from the area resource file (ARF). Using data on the 3794 hospitals classified as acute care facilities in 2002, we performed a set of logistic regressions that analyzed whether a hospital offered each of 74 distinct services. For each service (regression), key independent variables measured the number of other hospitals in the local market area that also offered the service. Local area market definitions are the areas circumscribed by the hospital within distances of 10 and 20 miles. Results suggest that contract-managed (CM) hospitals display a more competitive pattern (service duplication) than hospitals in general, but CM hospitals that are the sole provider of services locally are less likely to offer services than traditionally managed sole hospital providers. Contract management does not appear to offer any particular advantages in improving access to hospital services.     

一种基于service market模式的远程慢性病管理服务平台机制

目的:建立一种基于应用服务市场(service market)模式的远程慢性病管理服务平台机制。方法:通过将慢性病管理的各个环节软件服务化,在云平台上构建统一的慢性病健康管理应用服务市场。结果:各级医疗机构、医疗应用软件厂商等在统一平台上共享数据,便于推广优秀的慢性病管理方案。结论:基于service market模式的远程慢性病管理服务平台机制能够为慢性病患者提供更具个性化、更加便捷的慢性病管理服务。     

我国西部地区民营医院市场份额的熵权TOPSIS法评价研究

目的 明确医疗领域市场份额的内涵和外延,构建民营医院市场份额评价指标体系,分析我国西部十二个省、直辖市、自治区民营医院市场占有率,并探寻其主要的影响因素。方法 从医疗服务数量和服务收入两个层面构建民营医院市场份额评价指标体系,运用熵权TOPSIS法构建加权决策矩阵,找出有限方案中的最优和最劣方案,计算各评价对象与最优和最劣方案间的距离,进而获得评价对象与最优方案的相对接近程度,并以此作为评价排序的依据。结果 民营医院市场份额的熵权TOPSIS指数平均值为0.3921,综合评价排名最高的是西藏（0.9031）,最低的是广西（0.0438）。民营医院市场份额指标中权重较大的是民营医院住院药品收入比（0.1192）、住院检查费用收入比（0.1345）、住院手术费用收入比（0.1211）和住院其他费用收入比（0.1117）。结论 民营医院市场份额整体水平较低,且地区间存在较大差异;住院药品收入比、住院检查费用收入比、住院病人手术费用收入比和住院其他费用收入比是影响民营医院市场份额的主要因素。     

Straight talk new approaches in healthcare. The outpatient market: protect important market share

Hospitals are facing competition from myriad freestanding players in the outpatient market. It's a fight hospitals can't afford to lose because they often use outpatient profits to cover losses in other service lines. Indeed about 60% of the average hospital's operating margin depends on outpatient revenues. In this session of Straight Talk, we examine how hospitals can build and finance outpatient services with physicians, increasing their competitiveness in increasingly competitive markets.     

对深化医药卫生体制改革的再认识——学习《中共中央关于全面深化改革若干重大问题的决定》体会

以党的十八届三中全会通过的《中共中央关于全面深化改革若干重大问题的决定》为指导,进一步分析了我国医药卫生体制改革进展和瓶颈,对医疗卫生服务的产品属性、市场和市场在医疗卫生服务领域的作用、拓展和深化医药卫生体制和公立医院改革走向进行了剖析。文蕈认为：深化医药卫生体制改革应该从系统论观点出发,针对医疗卫生服务的复杂性．在界定不同医疗卫生服务产品属性的基础上,明确政府和市场的责任：统筹规划医疗卫生资源,进一步完善医药卫生的管理体制和运行机制,特别是公立医院的管理体制和运行机制,扭转公立医院的趋利倾向,向全体居民提供公平、可及、支付得起的公共卫生和基本医疗卫生服务：鼓励社会办医,满足广大人民群众不断增长的、多层次的医疗卫生服务需求。     

广州市医院门诊服务调查报告

目的：通过对医院门诊病人来源及流向调查，探求市场机制对医疗资源配置的影响，为科学制定医疗机构设置规划提供基础数据和决策依据。方法：采用市场调查和分析方法对广州市医院门诊病人的来源、流向及医疗机构服务范围、服务半径进行研究。结果：门诊病人87．90％为本市常住人口，12、10％为外来就医者。有34、14％的本市病人在本行政区就诊，跨区就诊的病人主要流向了三级医院。不同类型医院门诊服务的市场占有率不同。关联指数和承担指数分析表明，有些行政区居民对本区医疗资源依赖程度不高，有些行政区内医疗资源对本区居民的依赖程度不高。结论：提示制定医疗资源配置规划时，应结合市场机制对医疗服务市场的影响，合理配置医疗资源的总量、结构和布局。     

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.     

四川省医院市场结构的变化发展

利用2002—2017年四川省医院机构数据,从市场规模、市场份额和市场集中度方面分析医院市场结构的变化发展。结果:近年来医院数和床位数逐年上升,2002—2017年,医院总数从1 163所增长为2 219所,床位总数从118 593张增长为411 911张;医院数量的变化主要由一级公立医院的减少和一级民营医院增加引起。民营医院市场份额不断增加(2002—2017年床位、门诊服务、住院服务市场占比分别从3.71%、3.08%和3.12%增长为32.10%、17.78%和25.21%),但仍小于公立医院。医院市场竞争保持增大趋势,2017年约1.11%的医院市场处于完全竞争,11.11%垄断竞争,87.78%高度垄断。当前,公立医院继续主导医院市场,在新时代下,医疗供给侧改革的深化应仍然关注公立医院,同时尚有较大空间实施鼓励社会办医和促进竞争的相关政策。     

Hospital ownership and medical services: Market mix, spillover effects, and nonprofit objectives

Hospitals operate in markets with varied demographic, competitive, and ownership characteristics, yet research on ownership tends to examine hospitals in isolation. Here we examine three hospital ownership types – nonprofit, for-profit, and government – and their spillover effects. We estimate the effects of for-profit market share in two ways, on the provision of medical services and on operating margins at the three types of hospitals. We find that nonprofit hospitals’ medical service provision systematically varies by market mix. We find no significant effect of market mix on the operating margins of nonprofit hospitals, but find that for-profit hospitals have higher margins in markets with more for-profits. These results fit best with theories in which hospitals maximize their own output.