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Book part
Publication date: 11 August 2014

Lawton Robert Burns, Jeff C. Goldsmith and Aditi Sen

Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of…

Abstract

Purpose

Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway.

Design/Methodology Approach

We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models.

Findings

The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.

Research Limitations

While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization.

Research Implications

Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices.

Practical Implications

Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats.

Originality/Value

This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.

Details

Annual Review of Health Care Management: Revisiting The Evolution of Health Systems Organization
Type: Book
ISBN: 978-1-78350-715-3

Keywords

Book part
Publication date: 4 October 2012

Lawton Robert Burns, Douglas R. Wholey, Jeffrey S. McCullough, Peter Kralovec and Ralph Muller

Purpose – Research on hospital system organization is dated and cross-sectional. We analyze trends in system structure during 2000–2010 to ascertain whether they have…

Abstract

Purpose – Research on hospital system organization is dated and cross-sectional. We analyze trends in system structure during 2000–2010 to ascertain whether they have become more centralized or decentralized.

Design/Methodology/Approach – We test hypotheses drawn from organization theory and estimate empirical models to study the structural transitions that systems make between different “clusters” defined by the American Hospital Association.

Findings – There is a clear trend toward system fragmentation during most of this period, with a small recent shift to centralization in some systems. Systems decentralize as they increase their members and geographic dispersion. This is particularly true for systems that span multiple states; it is less true for smaller regional systems and local systems that adopt a hub-and-spoke configuration around a teaching hospital.

Research Limitations – Our time series ends in 2010 just as health care reform was implemented. We also rely on a single measure of system centralization.

Research Implications – Systems that appear to be able to centrally coordinate their services are those that operate in local or regional markets. Larger systems that span several states are likely to decentralize or fragment.

Practical Implications – System fragmentation may thwart policy aims pursued in health care reform. The potential of Accountable Care Organizations rests on their ability to coordinate multiple providers via centralized governance. Hospitals systems are likely to be central players in many ACOs, but may lack the necessary coherence to effectively play this governance role.

Originality/Value – Not all hospital systems act in a systemic manner. Those systems that are centralized (and presumably capable of acting in concerted fashion) are in the minority and have declined in prevalence over most of the past decade.

Details

Annual Review of Health Care Management: Strategy and Policy Perspectives on Reforming Health Systems
Type: Book
ISBN: 978-1-78190-191-5

Keywords

Book part
Publication date: 19 December 2013

Abstract

Details

Annual Review of Health Care Management: Revisiting The Evolution of Health Systems Organization
Type: Book
ISBN: 978-1-78350-715-3

Book part
Publication date: 19 December 2013

Abstract

Details

Annual Review of Health Care Management: Revisiting The Evolution of Health Systems Organization
Type: Book
ISBN: 978-1-78350-715-3

Content available
Article
Publication date: 28 September 2012

667

Abstract

Details

Leadership in Health Services, vol. 25 no. 4
Type: Research Article
ISSN: 1751-1879

Keywords

Book part
Publication date: 4 October 2012

Abstract

Details

Annual Review of Health Care Management: Strategy and Policy Perspectives on Reforming Health Systems
Type: Book
ISBN: 978-1-78190-191-5

Abstract

Details

International Journal of Leadership in Public Services, vol. 1 no. 1
Type: Research Article
ISSN: 1747-9886

Book part
Publication date: 20 October 2014

Michael F. Polgar, Carol S. North and David E. Pollio

This research documents the responsibilities and stresses of people with homeless relatives. Health and housing problems create a variety of challenges and sometimes…

Abstract

Purpose

This research documents the responsibilities and stresses of people with homeless relatives. Health and housing problems create a variety of challenges and sometimes burdens within families which are particularly stressful for family caregivers who are actively involved with helping homeless adults.

Design

Our study and data examine stress proliferation and stress buffering among people with homeless relatives using quantitative data from 118 interviews, mostly with parents and siblings of homeless adults.

Findings

Quantitative data from 118 interviews, largely from parents and siblings of homeless adults, show that people who spend more time or money helping homeless relatives experience higher levels of stress. Stress levels are also higher among those who help a homeless relative with activities of daily living and those who work to prevent harm that involves a homeless relative. Stress derived from efforts to prevent harm is associated with stronger social support to people with homeless relatives.

Value

Social and health service providers can provide helpful social support for both homeless people and for people with homeless relatives, particularly in circumstances where harm reduction is required.

Details

Family and Health: Evolving Needs, Responsibilities, and Experiences
Type: Book
ISBN: 978-1-78441-126-8

Keywords

Article
Publication date: 1 January 1978

The Equal Pay Act 1970 (which came into operation on 29 December 1975) provides for an “equality clause” to be written into all contracts of employment. S.1(2) (a) of the…

Abstract

The Equal Pay Act 1970 (which came into operation on 29 December 1975) provides for an “equality clause” to be written into all contracts of employment. S.1(2) (a) of the 1970 Act (which has been amended by the Sex Discrimination Act 1975) provides:

Details

Managerial Law, vol. 21 no. 1
Type: Research Article
ISSN: 0309-0558

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