Korea Journal of Hospital Management (한국병원경영학회지)

Korean Society of Hospital Management (한국병원경영학회)
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The Relationship between Hospital Specialization and Operational Performance: Focusing on Diseases of the Musculoskeletal System and Connective Tissue

병원의 전문화 전략과 운영성과 간의 관계: 근골격계 및 결합조직 질환을 중심으로

  • Seo, Seul-Ki (Department of Health Services Management, Kyung Hee University) ;
  • Kim, Yang-Kyun (Department of Business Administration, Kyung Hee University)
  • 서슬기 (경희대학교 일반대학원 의료경영학과) ;
  • 김양균 (경희대학교 경영대학 경영학과)
  • Received : 2020.06.03
  • Accepted : 2020.09.04
  • Published : 2020.09.30
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Abstract

This study is aimed at investigated and compared the differences in the affect of hospital specialization according to hospital size using claims data of the Health Insurance and Review Assessment National Inpatient Sample in 2018 for diseases of the musculoskeletal system and connective tissue. To this end, we used multivariate hierarchical linear models(a.k.a., multi-level models) using two-tier data from 106,599 patients discharged after diseases of the musculoskeletal system and connective tissue from 734 hospitals. Multivariate results indicate that patients who were discharged with diseases of the musculoskeletal system and connective tissue from specialized hospitals with 200 beds or less stayed shorter and paid less inpatient charge than those who were discharged from less specialized hospitals. But for hospitals with 201-300 beds, no positive impact relationship was found between hospital specialization and operational performance. This finding may be limited evidence that the affect of a hospital's specialization strategy may vary depending on the size of the hospital. We discussed several managerial and health policy implications below.

Keywords

References

  1. Zwanziger J, Melnick GA, Simonson L. Differentiation and Specialization in the California Hospital Industry 1983 to 1988. Medical care 1996;34(4):361-372. https://doi.org/10.1097/00005650-199604000-00007
  2. Kwak JM, Lee KS. Is the Hospital Caseload of Diagnosis Related Groups Related to Medical Charges and Length of Stay? The Korean Journal of Health Service Management 2014;8(4):13-24. https://doi.org/10.12811/kshsm.2014.8.4.013
  3. Bockhorn LN, Goytia RN, Laughlin MS, Patel AR. Increased Orthopedic Specialization Lowers Costs and Improves Outcomes in Total Joint Arthroplasty. The Journal of arthroplasty 2019;34(7):S76-S79. https://doi.org/10.1016/j.arth.2019.02.019
  4. Seo SK, Choi JY. Does Hospital Specialization Matter in Length of Stay and Inpatient Charges? Multilevel Analysis of Patients with Colon-rectal, Joint, and Cerebrovascular Diseases. Health Service Management Review 2019;13(1):17-26.
  5. Seo SK, Choi JY. Empirical Study on the Association between Specialization and Operational Performance among Small and Midsize Hospitals: Focusing on Diseases and Disorders of the Digestive System under DRG Payment. Health Service Management Review 2020;14(2):27-36.
  6. Oh YI, Park YS. Factors Affecting Duplicate Visits between Medical and Oriental Medical Institutions. The Korean Society of Health and Welfare 2017;19(1):7-26. https://doi.org/10.23948/kshw.2017.12.19.7
  7. Park SJ, Kim WS, Jan TD. Opioids and Antidepressants for Pain Control in Musculoskeletal. Disease Journal of the Korean Orthopaedic Association 2020;55(1):1-8. https://doi.org/10.4055/jkoa.2020.55.1.1
  8. Korean Statistical Information Service Homepage: Benefits by Classification of 22 Disease Categories 2010-2018 (cited 2020. Aug. 18) Available from http://kosis.kr/statisticsList/statisticsListIndex.do?menuId=M_01_01&vwcd=MT_ZTITLE&parmTabId=M_01_01
  9. HIRA. Healthcare Bigdata Hub Homepage (cited 2020. Aug. 19) Available from http://opendata.hira.or.kr/op/opc/olapMfrnIntrsIlnsInfo.do
  10. Park BS, Choi HG. A Case Study on the Specialization of Small and Medium-sized Hospitals Using Analytic Hierarchy Process-Based. Korean Review of Corporation Management 2020;11(1):191-213. https://doi.org/10.20434/KRICM.2020.02.11.1.191
  11. Masiye F. Investigating Health System Performance: an Application of Data Envelopment Analysis to Zambian Hospitals. BMC Health Services Research 2007;7(1):58. https://doi.org/10.1186/1472-6963-7-58
  12. Kim TK, Min HS, Jung HY. Knowledge and Performance Level of Infection Control with MRSA of Medium and Small Hospital Nurses. The Korean Journal of Health Service Management 2012;6(3):157-169. https://doi.org/10.12811/kshsm.2012.6.3.157
  13. Nam MH, Lim JH. The Influences of the Awareness of Patient Safety Culture on Safety Care Activities among Nurse in Small-Medium Sized General Hospitals. Journal of Digital Convergence, 2013;11(1):349-359. https://doi.org/10.14400/JDPM.2013.11.1.349
  14. Lee NK, Lee JO. A Study on the Architecture of Cloud Hospital Information System for Small and Medium Sized Hospitals. The Journal of Society for e-Business Studies 2015;20(3):89-112. https://doi.org/10.7838/jsebs.2015.20.3.089
  15. Cram P, Rosenthal GE, Vaughan-Sarrazin MS. Cardiac Revascularization in Specialty and General Hospitals. New England Journal of Medicine 2005;352(14):1454-1462. https://doi.org/10.1056/NEJMsa042325
  16. Greenwald L, Cromwell J, Adamache W, Bernard S, Drozd E, Root E, Devers K. Specialty versus Community Hospitals: Referrals, Quality, and Community Benefits. Health Affairs 2006;25(1):106-118. https://doi.org/10.1377/hlthaff.25.1.106
  17. Cram P, Vaughan-Sarrazin MS, Wolf B, Katz JN, Rosenthal GE. A Comparison of Total Hip and Knee Replacement in Specialty and General Hospitals. JBJS 2007;89(8):1675-1684. https://doi.org/10.2106/00004623-200708000-00002
  18. Hwang CW, Anderson GF, Diener-West M, Powe NR. Comorbidity and Outcomes of Coronary Artery Bypass Graft Surgery at Cardiac Specialty Hospitals versus General Hospitals. Medical Care 2007;45(8):720-728. https://doi.org/10.1097/MLR.0b013e3180537192
  19. Hagen TP, Vaughan-Sarrazin MS, Cram P. Relation between Hospital Orthopaedic Specialisation and Outcomes in Patients Aged 65 and Older: Retrospective Analysis of US Medicare Data. BMJ 2010;340:c165. https://doi.org/10.1136/bmj.c165
  20. Cram P, House JA, Messenger JC, Piana RN, Horwitz PA, Spertus JA. Percutaneous Coronary Intervention Outcomes in US Hospitals with Varying Structural Characteristics: Analysis of the NCDR(R). American Heart Journal 2012;163(2):222-229. https://doi.org/10.1016/j.ahj.2011.10.010
  21. Kim YH, Moon JW, Kim KH. The Determinant Factors and Medical Charges Pattern by Length of Stay in Hospital. Korea Journal of Hospital Management 2010;15(2):15-26.
  22. Elixhauser A, Steiner C, Harris R, Coffey R. Comorbidity Measures for use with Administrative Data. Medical care 1998;36(1):8-27. https://doi.org/10.1097/00005650-199801000-00004
  23. Leyland AH, Goldstein H. Multilevel Modelling Of Health Statistics. Epidemiol Community Health 2002;56(7):560. https://doi.org/10.1136/jech.56.7.560
  24. Hunter JE, Schmidt FL. Methods of Meta-Analysis: Correcting Error and Bias in Research Findings. Sage;2004.
  25. Do MS. Estimation of Mean Life and Reliability of Highway Pavement Based on Reliability Theory. Korean Society of Civil Engineers Magazine 2010;30(5):61-69.
  26. Glaser D, Hastings RH. An Introduction to Multilevel Modeling for Anesthesiologists. Anesthesia & Analgesia 2011;113(4):877-887. https://doi.org/10.1213/ANE.0b013e3182198a01
  27. Shin SS, Woo KS, Shin YJ. A Systematic Review of Studies on Public Health Using Multilevel Analysis: Focused on Research Trends and The Assessment of Risk of Bias. Health and Social Welfare Review 2015;35(4):157-189. https://doi.org/10.15709/hswr.2015.35.4.157
  28. Mukherjee A, Mitchell W, Talbot FB. The Impact of New Manufacturing Requirements on Production Line Productivity and Quality at a Focused Factory. Journal of Operations Management 2000;18(2):139-168. https://doi.org/10.1016/S0272-6963(99)00023-6
  29. Schneider JE, Miller TR, Ohsfeldt RL, Morrisey MA, Zelner BA, Li P. The Economics of Specialty Hospitals. Medical Care Research and Review 2008;65(5):531-553. https://doi.org/10.1177/1077558708316687
  30. Hyer NL, Wemmerlov U, Morris Jr JA. Performance Analysis of a Focused Hospital Unit: The Case of an Integrated Trauma Center. Journal of Operations Management 2009;27(3):203-219. https://doi.org/10.1016/j.jom.2008.08.003
  31. Skinner W. The Focused Factory. Harvard Business Review 1974;52(3):113-121.
  32. Hill CW. Diversification and Economic Performance: Bringing Structure and Corporate Management Back into the Picture. Fundamental Issues in Strategy: A Research Agenda, Harvard Business School Press, Boston 1994:297-322.
  33. Clark JR, Huckman RS. Broadening Focus: Spillovers, Complementarities, and Specialization in the Hospital Industry. Management Science 2012;58(4):708-722. https://doi.org/10.1287/mnsc.1110.1448
  34. Wruck KH, Jensen MC. Science, Specific Knowledge, and Total Quality Management. Journal of Accounting and Economics 1994;18(3):247-287. https://doi.org/10.1016/0165-4101(94)90023-X
  35. Nooteboom B. Learning and Innovation in Organizations and Economies. OUP Oxford; 2000.
  36. Greve HR. Organizational Learning from Performance Feedback: A Behavioral Perspective on Innovation and Change. Cambridge University Press;2003.
  37. Teece DJ, Rumelt R, Dosi G, Winter S. Understanding Corporate Coherence: Theory and Evidence. Journal of Economic Behavior & Organization 1994;23(1):1-30. https://doi.org/10.1016/0167-2681(94)90094-9
  38. Teece D, Pisano G. The Dynamic Capabilities of Firms: an Introduction. Industrial and Corporate Change 1994;3(3):537-556. https://doi.org/10.1093/icc/3.3.537-a
  39. Chandler AD, Hikino T, Chandler AD. Scale and Scope: The Dynamics of Industrial Capitalism. Harvard University Press;2009.
  40. Helfat CE, Finkelstein S, Mitchell W, Peteraf M, Singh H, Teece D, Winter SG. Dynamic Capabilities: Understanding Strategic Change in Organizations. John Wiley & Sons;2009.