Vertical Integration and Organizational Networks in Health Care

Robinson, James C.; Casalino, Lawrence P.

doi:10.1377/hlthaff.15.1.7

Cited by 206 publications

(115 citation statements)

References 8 publications

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“…22 It represents the devolution of a PHO into a holding company structure where the physicians and hospitals contract with each other on a nonexclusive basis rather than seek to create a vertically integrated system. 23 …”

Section: Methodsmentioning

confidence: 99%

Consolidation of Medical Groups Into Physician Practice Management Organizations

Robinson¹

1998

JAMA

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Section: Methodsmentioning

confidence: 99%

Consolidation of Medical Groups Into Physician Practice Management Organizations

Robinson¹

1998

JAMA

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“…We agree with Luke that health networks have evolved over time in these ways, but it is important to remember the context in which the taxonomy was developed. During the mid-1990s, health networks were engaged in efforts to develop organized delivery systems and they represented an alternative to tight ownership-based models (Dowling 1995;Robinson and Casalino 1996;Shortell et al 1996).…”

Section: Relevance Of Conceptual Framework To Health Network Versus mentioning

confidence: 99%

Rejoinder to Taxonomy of Health Networks and Systems: A Reassessment

Bazzoli¹,

Shortell²,

Dubbs³

2006

Health Services Research

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In his commentary on the taxonomy of health systems and networks that we originally developed in Bazzoli et al. (1999) and updated through Dubbs et al. (2004), Luke raises various concerns about the underlying concepts, measures, and approaches we used to develop our classification scheme. His primary concerns are: (1) a bias in system assignment occurs because the taxonomy categories capture multimarket configurations of systems rather than centralization per se; (2) hospital service configuration data do not provide relevant information about the locus of health system/network decision making; (3) the conceptual framework used may not be relevant for health networks; and (4) measurement error exists in certain variables. We address each of these issues in this rejoinder.Before commenting on these points, we note that our primary purpose for developing the taxonomy in the late 1990s was to examine the structure and strategy of health networks and systems as the American Hospital Association (AHA) and others defined them. The AHA had a long history of tracking these organizations, collecting information on multihospital systems starting in the mid-1970s and on health networks beginning in 1993. Over time, the objectives and structure of these organizations changed in response to changing market imperatives. Most notable was the movement in the mid1990s to develop organized delivery systems in anticipation of the Clinton administration's Health Security Act of 1994 and in response to the growing belief that capitated contracting between providers and health plans would become common. There was widespread acknowledgement among researchers and the industry that the organizations tracked by the AHA were growing more heterogeneous, and this led to concern that health services research that attempted to measure a system or network effect on hospital behavior would provide misleading information given the diversity of these organizations.

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“…Two developments are noteworthy. Firstly, these organisations have not been tightly structured like the classical staff model HMO ('vertical integration'), but tied together by internal contracting based around shared information systems ('virtual integration') (Robinson & Casalino 1996). Secondly, they have proceeded to the next step of offering their services directly to funders (that is, large employers), thereby cutting out the third-party intermediaries or, to put it another way, they have moved to take over or internalise the budget-holding function, in the same way as the classical␣ HMOs.…”

Section: Provider Restructuringmentioning

confidence: 99%

Managed competition:The policy context

Scotton¹

1999

Aust. Health Review

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In order to maintain universal access to medically effective care for all, costs must be contained at both the system-wide and micro levels. The managed competition model offers a framework within which increased efficiency could be pursued without sacrificing the goal of universal access and without impairing health outcomes and social cohesion. It would do this by removing structural impediments to rational decision-making and allocating to markets and governments the functions they perform best.

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Vertical Integration and Organizational Networks in Health Care

Cited by 206 publications

References 8 publications

Consolidation of Medical Groups Into Physician Practice Management Organizations

Consolidation of Medical Groups Into Physician Practice Management Organizations

Rejoinder to Taxonomy of Health Networks and Systems: A Reassessment

Managed competition:The policy context

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