Examining the Distinct Effects of Structural, Financial, and Information-Sharing Integration on Hospital Costs

초록

OBJECTIVE: Hospitals are pursuing integration strategies to contain costs, but evidence remains limited. This study examined the independent associations of 3 forms of integration-structural, financial, and information sharing-with hospital costs. STUDY DESIGN: Hospital fixed-effects panel regression using data from multiple sources-CMS Hospital Compare, Let's Get Healthy California, and the American Hospital Association Annual Surveys and Information Technology Supplements-for years 2014-2016. METHODS: Three integration dimensionswere measured: (1) structural integration (health maintenance organization [HMO] participation rate, hospital physician employment/foundation models, and system affiliation); (2) financial integration (% of the hospital's net patient revenue paid on a shared-risk basis); and (3) information-sharing integration (use of electronic patient data received from outside sources). Hospital fixed-effects regressions with 2-way clustering by hospital and county were estimated to assess within-hospital changes in spending associated with each dimension, controlling for 3 ownership types and size. RESULTS: Financial integration was associated with lower hospital spending, whereas structural and information-sharing integration showed no independent association. Considered jointly, the 3 integration dimensions were statistically significant as a group. These findings were robust to alternative specifications, including excluding HMO participation from the structural index, orthogonalizing financial integration to the other dimensions, and measuring information-sharing integration. Additional checks found no evidence that capitation adoption or the capitation share of revenue was related to lower spending. CONCLUSIONS: These findings suggest that carefully designed financial incentives should be prioritized when implementing integration measures in policy and practice.

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