1 / 46

: :

2. ???????. ????(S). . ??(C). ????(P). . ???????????????????????????????. ?????????. ??( Cost )??( Quality). 3. ???????. ????????????????????????????(Entry Barrier)?????(GO)????(NPO-NGO)???. 4. ????????. ????????????????????????????????(??????????????). 5. ??????????. ??????????

geoffrey
Download Presentation

: :

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. 1 ???????? ????:??????????? ????:????????????? ?????????

    2. 2 ???????

    3. 3 ??????? ???????? ????? ????????? ??????(Entry Barrier) ?????(GO)????(NPO-NGO)???

    4. 4 ???????? ????????????? ?????? ???????? ?????(??????????????)

    5. 5 ?????????? ?????????????????????:????????????????? ?????????????????,????????????????: ???????????????:????;???????????:?????? ? ?????????,???????????????????

    6. 6 ???????????? Gaynor and Vogt(2000)?????,???????????,???????????????: ???????????????:???????????????????????????????,????????????? ?????????????????????? ???????????????????? ?????????????????? ???????????? ????????(supplier-induced demand) ?????

    7. 7 ???????????????? ???? ???? ?????? ?????????????? ??????????? ?? ???????????????????????; ???????,???????????,????????????

    8. 8 ????????? ?????????,???????????????????,?????????????,?????????????????? ???????,???????????????,?????: ?????????; ????,?????????????????; ??????????????? ?????????????????????

    9. 9 Why Not-for profit (NPO)? ?????????????????? ?Arrow(1963)?????????????,???????????????????:???????????????,???????????????,????????????? ???????????????????? ?Bays(1983)?????????,????????????????,?????????????,??????????????

    10. 10 ???????(GO)? ?????????noncontractible???,????? ?Hart et al. (1997)?????????????????,?????????????????????????? ?????????,???????????????noncontractible quality??????? ???????????????????? Gertler(1998)?????:???????????,????????????????????

    11. 11 ?????????? ???????? ???????,??????????????????,????????????Pauly and Redisch(1973)????????????? ???????? Duggan(2000)?????,????????????????????,???????????????,????????????????????????

    12. 12 ?????? ????????????? ????????? ????????? ????????????

    13. 13 ????????????? 1. ????????????????????,???????? 2. ???????????????????????(Hoeger, 1991) ? 3. ???????????????,???? ???????????????;?????????,????????????????(Lynk, 1995) ? 4. ?????????????????????????????????,????????????(Duggan, 2000) ?

    14. 14 ???????? ??????????,??????????? ?????????????????????,???????????? ???,????????????????,???????????????

    15. 15 ????????? ??????????? ???????(patient-driven competition): ????? ????????(payer-driven competition):???? ?????????????

    16. 16 Patient-Driven Competition ???????????????????,?????????????????“good shoppers”???: 1.??????????,???????????? 2.????????????????? ??????,?????????????,???????(????primary care physicians)?????(agent)???,??????????? ??????,????????????,??????????????????(??)?????????Dranove??(1993)???????“???????”(patient-driven competition)?

    17. 17 Patient-driven Competition????? ??????????,??????????????????,???????????,?????????? ?????????????????(medical arms race) ?

    18. 18 The Medical Arms Race(MAR) ??????????,?????????????????????,?????????? ?????????????????????????,???? Medicare?Medicaid????? ?????????????????????????????????????????????,?????????????,??????????

    19. 19 MAR??? ????,MAR?????????????,?????????????????:“In the MAR, hospitals compete for physicians and their patients by providing the latest technology, excessive staffing, and lavish amenities.” Enthoven(1978)???????:MAR?????????,??????????“social optimum”? ?????????????????????????(practice makes perfect),?MAR??????????????,????????????

    20. 20 ??MAR??????? ????????????????(reduced form): Y= f (H, X) Y ?????????; H ???????,???????? ?; X ?????????

    21. 21 ????? ??????????(concentration ratio)??????????? ????????????: 1)???????:????????????? 2)????(Herfindahl-Hirschman Index): ????50????????????????? ?????????,??????????;???????,???????????

    22. 22 ????????? ??????:HHI=100 × 100=10,000 ??????:HHI=0.12 × 50 =0.5 ? 0 (??50???,????????0.1%) ??,????????0,???10,000 ??????????: ????:HHI<1,000 ????:1,000<HHI<1,800 ????:HHI>1,800

    23. 23 MAR??????? Robinson & Luft (1985):???????????,??????????,??MAR??? Zwanziger & Melnick (1988):???????????????,??????????:1983??????????MAR???,1985??????????? Dranove et al. (1992):???????????????????,????MAR???????

    24. 24 Patient-driven competition??? Arrow(1963)?????,?????????????: ???:???????????????; ???:?????????? Arrow?????????(???)???????,?????????: ???:?? ???:???????(??????)? ????????????????????????????????????????????????(??)????????,????provider?????????????,??????????,??????????????,?????????????

    25. 25 Payer-driven competition?????1 ???????Medicare?Medicaid programs??????????payers,???????????,??payer??????bargaining power,???????????:1.?1983??????PPS;2.?1992????????RBRVS? ??????????????“???”,???????????????,??????????????????,??????????????,????????????:Preferred Provider Organizations(PPOs)?

    26. 26 Payer-driven competition????2 PPOs???payer????????,??????????(discounted price),?payer?????????????????(preferred providers)?????Payer???????????????:?????????,????????????????? PPO????????????(selective contracting),?????payer????,?????PPO???HMO????????? ????PPO?HMO??,????????????????payers? Payer?????????,????????????;payer???????????????,??????????????,????????????????,???????????????

    27. 27 Payer-driven competition????3 PPO?????????? 1.Larger purchasers obtain bigger discounts. (Melnick et al.,1992) 2.???????PPO??,???????????(???????),?????????????????HMO?PPO??,??????????????? 3.?patient-driven competition??,??????????????????,???????????,?????????????????,?PPO???????????????????,???????????

    28. 28 Payer-driven competition?????4 ?PPO???,??????????????,?????????????? PPO????,?????????????????(player),?????????,?????????????????Dranove??(1993)?????payer-driven competition?

    29. 29 Payer-driven competition????? ??????????????,???????????(price per day)???????(price per discharge)? ????????????,???????????????????: 1.??????? 2.?????????????? 3.???????????????? 4.The hospital’s price/cost margin

    30. 30 PPO????????? ???,????????????????????????????,???????????????????(????),???????????????????(?p)? ?PPO??????????, ?p????????offer(??)?PPO??????PPO?????????????,????????PPO????????,???????????????????PPO??,???????????????????????

    31. 31 PPO????????? ???,????????????????,???,??????????????????? ?????,PPO?????????????????????????????????????????????,????????????????PPO?????????????????????? ??patient-driven competition????,?????????????,??PPO??????????????;?????????????,?PPO??????????????????????? ???,PPO?????????????????????????????????PPO???????????????????????,?????????????????

    32. 32 PPO??????? ???,PPO???????????????????:????????????????PPO??primary care physicians,??????????????? ????,PPO?????????????:??????????????????????????

    33. 33 Payer-driven competition ????? 1.??PPO(?managed care)??????? 2.?????????????

    34. 34 ??PPO??????? Dranove??(1998)?????:PPO????????????????????excess capacity???????????,Dranove?????:???????????????????,???????????????? ???????????,??????:????????????????????:1.????? 2.???? 3.???????? ???????:?Patient-driven competition??,??MAR???,?????????????????(??????????,???????,????);??Payer-driven competition??,????????????????:???????(?????),selective contracting???,?????

    35. 35 Dranove et al. (1993)??? ???????1980?????,?????????????? 1983??????,???????????????,?1988??????????????????? ??????,???????1980?????patient-driven competition,??1980?????managed care??????,????payer-driven competition?

    36. 36 ?????1 Payer-driving competition???????,???????????????????????,????????????? ???????,??:1.???????,??????????? 2.??????????,?????????????? ???????,???????????????????????????????????????????,??: 1.??????,?????????????,??????? 2.????????payer???????????????,??????????????

    37. 37 ?????2 ??PPO?????,??????????,????????????? Dranove and Satterthwaite (2000)??:???????????,?????????PPO????????????????,???????????????????????,????????????

    38. 38 ????????????? ?????????????,???????????????: ?????:????????????,????????????????? ?????:???????,????,??????????????????????????

    39. 39 ?????????????? ??????????????: ????????????,?????????????,???????????????????????????,??????????????????????,???????????????? ????????,?????????? ????????????,????????????? ??????????????,???????????????????????????????????

    40. 40 ?????????????? MAR??,??????????????,??????????????? MAR?????????,??managed care???????????????????,??????MAR????????????? ??managed care plan??????????????????????,?managed care????????????????,??????? (cost-effective)??????

    41. 41 ????????????????? ????????????????,???????????????,????????????? ?????(Pro competition) ?????????????????? (????),??????????????????? (????????),??????? ????(Anti competition)

    42. 42 ??????????? ????????????????????? ???????????,????????: 1.????1980???????????:???????????????????????????patient-driven competition????,?????????????????? 2.????????????????:????????????????????,??????????payer-driven competition????,???????????????? 3.???????:?????????,??????????????

    43. 43 ????????? ??????????????????????????????,??????????????????????????,?????????????,?????????«??????»???,???????????,???????????????? ??????????????????,?????????????????????????????????????????,???????????

    44. 44 Kessler and McClellan (2000) ??1985??1994???,4????Medicare??????,????????????????? ?????AMI????????,??travel distances????????,?????managed care????????????????????????????????????,????????????????????

    45. 45 Kessler and McClellan (2000) ????????????????expenditures on treatment (social cost) and patient health outcomes (social benefits). ??????:???????1980?????,????????????,?1990?????????,??????????????:?????????,??????????(????),?????(????)???HMO?????(???managed care?????)?????????????????????

    46. 46 ????????????????1 ????????????????,??????????????????? ???????,??????????????? ???????????,?????????????????:????????????????,????????? ????????????,???????????????,?????????????,?????????????

    47. 47 ?????????????2 ????????????,??????????????,??????????????? Kessler and McClellan(2000)?????:???????????????????,?????AMI???????,??????????????,????????????????

More Related