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Information technology outsourcing in United States hospital systems.

機(jī)譯：美國(guó)醫(yī)院系統(tǒng)中的信息技術(shù)外包。

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The purpose of this study was to determine the factors associated with outsourcing of information systems (IS), and if there is a difference in IS sourcing based on the strategic value of the outsourced functions. The theoretical framework is based upon a synthesis of strategic management theory (SMT) and transaction cost economics (TCE) as they apply to vertical integration in the health care sector; therefore, IS sourcing behavior was conceptualized as a case of vertical integration. The conceptual model proposed that sourcing behavior would be determined by asset specificity, uncertainty, the interaction of asset specificity and uncertainty, bargaining power, corporate strategy needs, and the strategic value of the IS functions outsourced.;A cross sectional design was used, consisting of data from the American Hospital Association (AHA), the Area Resource File (ARF), the HIMSS Analytics database, and the Centers for Medicare and Medicaid Services (CMS) hospital cost reports for 2003. The final sample consisted of 1,365 health care delivery systems and 3,452 hospitals.;Analysis was conducted using a two-stage negative binomial regression model (using instrumental variables) to correct for suspected endogeneity. Tests of joint restrictions using the group of variables derived from TCE and SMT, respectively, were done with the dependent variable divided between strategic and non-strategic IS functions (the division was done based on a model of Core IS Capabilities developed as a model for a high-performance IS function).;The results supported the relationship between bargaining power and IS outsourcing. Results for asset specificity and corporate strategy needs were significant in the opposite direction than hypothesized. No other findings were significant. These results suggest that hospital system managers are likely not considering significant factors when making sourcing decisions, including the relative strategic value of the functions they are outsourcing.;This study contributes to the limited body of knowledge surrounding IS sourcing behavior in the health care sector. Future research should examine the effect of cost on IS sourcing decisions, and consider the use of alternative theoretical frameworks, particularly Institutional Theory.
機(jī)譯：這項(xiàng)研究的目的是確定與信息系統(tǒng)外包（IS）相關(guān)的因素，以及根據(jù)外包職能的戰(zhàn)略價(jià)值在IS采購(gòu)方面是否存在差異。該理論框架基于戰(zhàn)略管理理論（SMT）和交易成本經(jīng)濟(jì)學(xué)（TCE）的綜合，因?yàn)樗鼈冞m用于醫(yī)療保健部門的縱向整合；因此，信息系統(tǒng)采購(gòu)行為被概念化為垂直整合的案例。該概念模型提出，采購(gòu)行為將由資產(chǎn)特異性，不確定性，資產(chǎn)特異性與不確定性的相互作用，討價(jià)還價(jià)能力，公司戰(zhàn)略需求以及外包的IS功能的戰(zhàn)略價(jià)值所決定。數(shù)據(jù)來(lái)自美國(guó)醫(yī)院協(xié)會(huì)（AHA），區(qū)域資源文件（ARF），HIMSS分析數(shù)據(jù)庫(kù)以及2003年醫(yī)療保險(xiǎn)和醫(yī)療補(bǔ)助中心（CMS）的醫(yī)院費(fèi)用報(bào)告。最終樣本包括1,365個(gè)醫(yī)療服務(wù)提供者系統(tǒng)和3,452家醫(yī)院。；使用兩階段負(fù)二項(xiàng)式回歸模型（使用工具變量）進(jìn)行分析，以校正可疑的內(nèi)生性。使用分別來(lái)自TCE和SMT的變量組對(duì)聯(lián)合限制進(jìn)行測(cè)試，將因變量分為戰(zhàn)略性和非戰(zhàn)略性IS功能（該劃分是基于開發(fā)為用于以下方面的模型的核心IS能力模型完成的）一個(gè)高性能的IS功能）。結(jié)果支持議價(jià)能力與IS外包之間的關(guān)系。資產(chǎn)專用性和公司戰(zhàn)略需求的結(jié)果與假設(shè)的相反，意義重大。沒(méi)有其他發(fā)現(xiàn)是有意義的。這些結(jié)果表明，醫(yī)院系統(tǒng)管理者在制定采購(gòu)決策時(shí)可能不會(huì)考慮重大因素，包括其外包職能的相對(duì)戰(zhàn)略價(jià)值。此項(xiàng)研究導(dǎo)致醫(yī)療保健部門圍繞IS采購(gòu)行為的知識(shí)有限。未來(lái)的研究應(yīng)檢查成本對(duì)信息系統(tǒng)采購(gòu)決策的影響，并考慮使用替代性理論框架，尤其是制度理論。

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