Advances in Health Care Management: Volume 1


Table of contents

(17 chapters)

Competitive and regulatory forces have spurred the consolidation of health care provider and payer groups into large integrated care delivery systems that purchase freestanding clinics. Many private practitioners, unable to stand alone against these competitive pressures, are selling their practices and becoming employees, often for the first time in their careers. Consequently, many physicians are now embarking on transition journeys into dual organizational/professional careers. Anecdotal evidence suggests that many transitioning physicians feel alienated and are ‘grieving’ their loss of autonomy. Others, however, seem enthusiastic about employment and embrace their new organization. What explains these differences in physician transitions?In this chapter, we develop a model to explain the variation in transition experiences. We induce the components of this model from two sources. First, we use four case studies to illustrate themes that emerged from our interviews with 21 physicians recently employed by a large integrated health system. Second, we draw upon received theory from management literature, including research on career transitions and organizational and professional commitment.Integrating the concepts induced from the interviews and the literature, we specify a model of physician transition, in which dual commitment to both profession and organization serves as the key indicator of transition. We propose that transition to dual commitment is a function of: (a) individual differences in demographics and value orientation and (b) organizational characteristics such as hygiene factors and enablement. We also propose that dual commitment will produce benefits in terms of job satisfaction, patient satisfaction, and clinical quality. Finally, we discuss the model's implications for practice and theory.

In the near future, today's medical students will be working increasingly in a variety of settings and directly interacting with the public. Although a patient's interaction with a physician ordinarily represents only one aspect of a specific health experience, one could argue that the quality of this particular interaction is of considerable importance to patients. Central to this interaction is the notion of service orientation, which has been defined as those attitudes and behaviors that influence the quality of the interaction between service providers and consumers. This chapter presents a description of research on the concept of service orientation among a sample of medical students. The results indicate that medical students exhibiting greater levels of service orientation are those who are older, female, married, and who place greater emphasis on their future incomes and perceptions of patient expectations for the service quality dimensions of responsiveness and tangibles.

Recent premium increases imposed by managed care plans raise a serious question about the long-run viability of managed care as a solution for controlling health care costs. The last decade's growth of total expenditures on health care has only been modestly influenced by managed care reimbursement policies. It is clear that other variables, besides reimbursement policies, must be considered in the effort to achieve a fiscally sound health care system. This chapter explores the role of investments in management staffing as a predictor of sound financial performance in medical groups. Investments in management staffing by multispecialty groups surfaced as a consistent predictor of higher gross charges, net revenue and operating margins, and lower operating costs. Investments in management staffing surfaced as a predictor of lower operating costs and higher operating margin for specialty groups. The implications of these findings for practice, theory and research are discussed.

This chapter employs a case study research design to investigate why and how nursing facilities are entering into relationships with hospital systems and managed care. Resource dependence theory provides the conceptual framework for analysis of data from a seven-market case study. These data indicate that nursing facility relationships with systems and managed care vary depending on local circumstances. However, nursing facilities nationwide are providing more specialized care of higher acuity in response to market opportunities. In the context of the current market environment, the implementation of case mix reimbursement under Medicare's Prospective Payment System for skilled nursing facilities may have unanticipated consequences, including a reduction in the number of Medicare-certified facilities, a reduction in the number of hospital-based facilities, and changes in facility staff composition. Both policy and managerial implications are considered.

The major objective of this research is to examine and characterize service delivery systems for persons with mental illness in a resource scarce environment, i.e. a rural area characterized by persistent poverty and disadvantaged poulations. Although a number of studies have investigated the integration of mental health, general health, and social services, few have focused on systems of care in rural areas. To characterize service delivery systems, this exploratory study uses a case study approach that includes network analysis, quantitative analysis, and a system assessment. The findings suggest that scarcity of resources in these rural environments is an overriding factor in the development of an integrated service delivery system for persons with a mental illness. With no psychiatrists, long waits for commitment, and few emergency accomodations, these rural environments afford service providers little opportunity for proactive or strategic planning. In fact, we view the development of integrated (e.g. client referral and technical information exchange) service networks in rural communities, especially areas of extreme resource scarcity, as problematic. The resource exchange networks that exist are best characterized as informal, moderately centralized, and of limited density. This translates into a system of care that is provider-driven and crisis-oriented.

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Advances in Health Care Management
Series copyright holder
Emerald Publishing Limited
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