当价格对病人无关紧要时,评估医院竞争:使用时间弹性。

Marco Varkevisser, Stéphanie A van der Geest, Frederik T Schut
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引用次数: 63

摘要

若干欧洲国家的医疗保健改革为医疗保险公司提供了激励措施和工具,使其成为谨慎的医疗保健购买者。这一策略的潜在成功关键取决于保险公司对-à-vis医疗保健提供者的议价杠杆。保险公司议价能力的一个重要决定因素是消费者考虑替代供应商的意愿。在本文中,我们研究了消费者在完全覆盖医院服务时愿意转换医院的程度,这在许多欧洲国家是典型的。由于价格对这些患者无关紧要,我们估计时间弹性来评估医院的可替代性。利用荷兰一家大型健康保险公司2003年非紧急神经外科门诊医院访问量的数据,我们估计了考虑到患者异质性和医院特征的患者医院选择的条件logit模型。我们使用参数估计来模拟每个病人的旅行时间人为增加10%的需求效应,同时保持所有其他医院属性不变。总体而言,医院时间弹性的结果点估计值相当高,尽管差异很大(-2.6到-1.4)。敏感性测试表明,这些估计值非常可靠,在各个医院之间差异很大。这意味着我们研究样本中的所有医院都至少有一个接近的替代品,这是医院有效竞争的重要前提。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Assessing hospital competition when prices don't matter to patients: the use of time-elasticities.

Health care reforms in several European countries provide health insurers with incentives and tools to become prudent purchasers of health care. The potential success of this strategy crucially depends on insurers' bargaining leverage vis-à-vis health care providers. An important determinant of insurers' bargaining power is the willingness of consumers to consider alternative providers. In this paper we examine to what extent consumers are willing to switch hospitals when they are fully covered for hospital services, which is typical for many European countries. Since prices do not matter to these patients, we estimate time-elasticities to assess hospital substitutability. Using data from a large Dutch health insurer on non-emergency neurosurgical outpatient hospital visits in 2003, we estimate a conditional logit model of patient hospital choice taking both patient heterogeneity and hospital characteristics into account. We use the parameter estimates to simulate the demand effect of an artificial increase in travel time by 10% for every patient, holding all other hospital attributes constant. Overall, the resulting point estimates of hospitals' time-elasticities are fairly high, although variation is substantial (-2.6 to -1.4). Sensitivity tests reveal that these estimates are very robust and differ significantly across individual hospitals. This implies that all hospitals in our study sample have at least one close substitute which is an important precondition for effective hospital competition.

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