Motives for Health Plan-Academic Health Center Relationships: Journal Review of the First Quarter Century

Abstract

Motives for health plan (HP)-academic health center (AHC) relationships, including both deterrents and inducements, are explored through a review of 153 articles, published from 1970 through 1997, in academic and health care industry journals about HP-AHC relationships. Every article that met inclusion criteria was coded for year, journal, author, audience, type of article, organization of focus, purposes, priorities, affiliation motives, and issues. Peak years were 1973 (the passage of HMO legislation) and the most recent years from 1994 through 1997. The motives to affiliate were found to be different for AHCs and HPs (e.g., physician attitudes, a deterrent for AHCs and inducement for HPs; resources, a deterrent for HPs and inducement for AHCs). Increases in size of HPs and decreases in political power of AHCs have resulted in changes to motives to form relationships. Motives must be acknowledged to move from competitive to collaborative relationships. PURPOSE OF STUDYIt is now commonplace to observe that the past 25 to 30 years have been a period of substantial organizational change in the health care system. There has been an overwhelming amount of commentary and study that has focused on evolution and change in the expanding variety of healthcare organizations including hospitals, physicians' practices, health care insurers, 106 and employer groups, as well as academic health centers (AHCs) and health plans (HPs). AHCs educate and train the nation's future physicians and other health care professionals, conduct clinical research, and frequently provide medical services to the sickest and often poorest Americans. HPs combine the attributes of medical delivery systems with health insurance and cover the medical needs of a majority of Americans. Together, these two institutional sectors have had a tremendous impact on the quality and availability of medical services in this country. However, the relationships of AHCs and HPs have not been studied in depth. Two current debates make this review of more than passing interest. First, AHCs are experiencing stress in competing in today's cost-constrained health care markets as their costs for education of health professionals, clinical research, and service to impoverished populations continue to increase (Friedman 1997;Moore and Griner 1997;Pardes 1997). Second, recent legislative debates, such as patient's bill of rights and HMO liability, as well as other consumer concerns, have sparked controversy over the quality of care that patients receive from HPs. These challenges exemplify the importance of examining how AHCs and HPs interact with one another as market and regulatory pressures continue to intensify.Application of the organizational literature on alliances would suggest that HPs and AHCs might form alliances in response to market, regulatory, or community forces, particularly if they are in the same service area and/or are suppliers and purchasers of each other's products (Oliver 1990). However, this review of trade and academic reporting of HP-AHC relati...

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