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1、ImpactoftheNHSreformsonEnglishhospitalproductivity:ananalysisofthefirstthreeyears1.NeilSöderlund,researchfellowa,2.IvanCsaba,researchfellowb,3.AlastairGray,seniorresearchassociateb,4.RuairidhMilne,seniorlecturera,5.JamesRaftery,healtheconomistc+AuthorAffiliations1.aDepartmentofPublicHea
2、lthandPrimaryCare,UniversityofOxford,OxfordOX26HE2.bCentreforSociolegalStudies,UniversityofOxford,OxfordOX26UD3.cNationalCasemixOffice,WinchesterSO225DH1.Correspondenceto:DrNeilSöderlundCentreForHealthPolicy,UniversityoftheWitwatersrandMedicalSchool,SAIMR,POBox1038,Johannesburg2000,Sout
3、h·Accepted21May1997 NextSectionAbstractObjectives:Toevaluatetheeffectofpurchasermix,marketcompetition,andtruststatusonhospitalproductivitywithintheNHSinternalmarket.Methods:HospitalcostandactivitydataweretakenfromroutinelycollecteddataforacuteNHShospitalsinEnglandfor1991–2to1993-4.Cross
4、sectionalandlongitudinalregressionmethodswereusedtoestimatetheeffectoftruststatus,competition,andpurchasermixonaveragehospitalcostsperinpatient,afteradjustingforoutpatientactivitylevels,casemix,teachingactivity,regionalsalaryvariation,hospitalsize,scaleofactivity,andscopeofcasestreated.
5、Results:RealproductivitygainswereapparentacrossthestudyperiodforNHShospitalsonaverage.Casemixadjustmentdrasticallyimprovedcrosssectionalcomparisonsbetweenhospitals.Gainingtruststatusandincreasinghostdistrictpurchasersharewereassociatedwithproductivityincreasesafteradjustmentforcasemix,r
6、egionalsalarydifferences,andhospitalsizeandscope.Hospitalsthatbecametrustsduringthestudyperiodwereonaveragelessproductiveatthebeginningoftheperiodthanthosethatdidnot,andtherewerenosignificantproductivitydifferencesbetweentrustwavesattheendoftheperiodin1993-4.Marketconcentrationwasnotass
7、ociatedwithproductivitydifferences.Conclusion:Furtheranalysisisneededtodeterminewhetheroverallandtrustassociatedproductivitygainsaretransienteffects,oneoffshifts,orselfperpetuatingreorientationsoforganisationalbehaviour.Hospitalsmayhavechosentobecometrustsbecausetheyanticipated