Physician-hospital Integration Research Articles

Physician-hospital integration and the economic theory of the firm.

Physicians and hospitals are pioneering new and more coordinated organizational forms under pressure from market competition. Arms-length "doctor's workshop" relationships are yielding to integrated delivery systems and contractual delivery networks. This article analyzes organizational change in health care through the conceptual lens of institutional economics, defined broadly as including agency theory, transactions cost economics, and the dynamic capabilities view of the firm. These theoretical frameworks highlight three distinct functions of organization under managed care: coordination, governance, and innovation.

You are in charge of cost

Shifts in medical reimbursement dictate that physicians become knowledgeable about resource consumption. Price drives cost. The patient is now a cost center. Various models of physician-hospital integration are presented. A completely integrated staff in the hospital has the greatest potential for economic efficiency. The best method of cost accounting will include activity-based costs in a format that is understandable for physician education. Hospital cost management involves human resources, ordering practices, length of stay, purchasing, capital requirements, and benchmark targets. As health reform takes shape, physicians should be fully cognizant of cost, understand healthcare issues, and commit to improving the environment in which they practice medicine. The purpose of these activities is to improve the value of healthcare delivery for all patients.

Hospital-physician integration: case studies of community hospitals.

Hospitals are attempting more meaningfully to involve physicians in management as one approach to increasing the efficiency and effectiveness of their operations. The purpose of this research was to explore the relationship between the structure of the medical staff organization, the extent to which physicians are integrated into hospital decision making and the hospital's financial performance. A measure of hospital-physician integration was developed based on Alexander et al's (1986) dimensions of hospital-physician integration which were based on Scott's (1982) organizational models, ie, autonomous, heteronomous and conjoint. A multiple case study design, which comprised eight community non-teaching hospitals over 200 beds located in the Province of Ontario, Canada, was used to examine the relationship between variables. Study results suggest that there is variation among community hospitals on both contextual and organization factors. Hospitals with high levels of hospital-physician integration were located in highly populated areas, had formulated and implemented a strategic plan, had highly structured medical staff organizations, and had no budgetary deficit. In contrast, hospitals with moderate or low levels of integration were more likely to be located in lowly populated areas, had little planning activity, had a moderately structured medical staff organization, and had deficit budgeting. Suggested areas for future research include examining the role of the Board of Trustees in determining physicians' organizational roles and identifying differences in commitments, characteristics, and motivations of physicians working in rural versus urban hospitals and their impact on integrative strategies.

Effects of Competition, Regulation, and Corporatization on Hospital-Physician Relationships

Recent changes in the hospital operating environment and physician-supply patterns have begun to erode the historical separation between hospital management-governance and physicians. We examine alternative mechanisms whereby physicians are integrated into the hospital's management-policNmaking structure and test a number of hxpotheses related to the conditions under which various forms of integration occur. Because regulatory intensity, physician competition, and hospital corporatization enhance managerial power vis-a-vis physicians so that there is greater balance, they are hypothesized to result in more integrated hospital-physician relationships. Results of multivariate analyses of a sample of 1, 981 general, short-term hospitals provide general support for our hypotheses regarding the effects of regulation and physician competition; however, the degree and type of hospital-physician integration are shown to varY by the ownership of the corporate organization with which the hospital is affiliated.