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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 these…

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: 25 July 2008

Richard A. Culbertson and Julia A. Hughes

The voluntary hospital trustee has traditionally seen issues of medical care, including those of patient safety, as falling within the delegated sphere of the medical staff. This…

Abstract

The voluntary hospital trustee has traditionally seen issues of medical care, including those of patient safety, as falling within the delegated sphere of the medical staff. This customary distancing of the trustee from direct involvement in patient safety issues is now challenged by unprecedented scrutiny of hospital safety results through voluntary disclosure or mandatory public reporting. This new climate, fostered by the Institute of Medicine's To Err is Human and the Institute for Healthcare Improvement's 100,000 Lives campaign, has complicated the role of the trustee in satisfying the traditional “prudent person” test for meeting fiduciary obligation as the trustee's breadth of involvement expands. Viewed theoretically, Mintzberg models the hospital as a case of a professional bureaucracy, in which the professional staff is responsible for standard setting and regulation. This traditional role of the professional staff is potentially assumed by others lacking technical background. Trustees are now asked to examine reports identifying physician compliance in attaining safety standards without education in the practice supporting those standards. Physician board members, whose numbers have increased in the past decade, are often sought to take the lead on interpretation of patient safety standards and results. The very public nature of patient safety reporting and its reflection on the reputation of the organization for which the trustee is ultimately accountable create a new level of tension and workload that challenges the dominant voluntary model of trusteeship in the United States health system.

Details

Patient Safety and Health Care Management
Type: Book
ISBN: 978-1-84663-955-5

Book part
Publication date: 30 December 2004

Thomas T.H. Wan, Yen Ju Lin and Bill B.L. Wang

The relationships of physician practice characteristics, care management effectiveness, autonomy, and managed care involvement, and physicians’ practice and career satisfaction…

Abstract

The relationships of physician practice characteristics, care management effectiveness, autonomy, and managed care involvement, and physicians’ practice and career satisfaction were investigated. A panel sample (N=660) of 6800 physicians was made up of eleven physicians randomly selected from each of the sixty communities. Three latent constructs include care management effectiveness, practice autonomy, and openness in private practice. Multilevel modeling was performed. A statistically insignificant association was found between the perceived effectiveness of care management and physician satisfaction, holding the practice characteristics and other perception factors constant. The study demonstrated direct effects of practice characteristics and care management effectiveness on the practice of gate-keeping functions and on earnings. Only two contextual variables, managed care penetration and median income in the study communities, were related to physicians’ practice.

Details

Chronic Care, Health Care Systems and Services Integration
Type: Book
ISBN: 978-1-84950-300-6

Book part
Publication date: 11 July 2007

Jerome Joffe

This paper examines how medical practice, like all other productive activities, has been subject to the transformative elements of the forces and the relations of production…

Abstract

This paper examines how medical practice, like all other productive activities, has been subject to the transformative elements of the forces and the relations of production involving class struggle and intra-class conflict. It will explore changes in the relations of production of medical practice which have been catalyzed by powerful productive forces. The current period of medical production involves the transformation of simple commodity production into a transitional stage of capitalist production with the seemingly unbounded growth of the medical productive forces. This development was precipitated by the intervention of capital as a whole, to restrict the drain on their variable capital through the placement of units of financial capital into the management of medical production, using the leverage of access to patients. In response, physicians have consolidated and centralized their practices to create enterprises with market power to limit the extraction of surplus by financial capital, and by their own employment of productive labor to extract surplus from hired physician labor and other clinical workers. Rationalization of the production of medical service commodities, and the sharing of surplus generated from exploitation of an expanded labor force by managed care financial capital and their capitalist partners owning medical enterprises, constitutes the contemporary relations of production. The contradictions of this mode of medical production and the potential for its reproduction will be analyzed.

Details

Transitions in Latin America and in Poland and Syria
Type: Book
ISBN: 978-1-84950-469-0

Book part
Publication date: 12 September 2001

Kathleen Montgometry

In this paper, I review the many research contributions that have advanced our knowledge about the role and impact of physician executives during the recent era of managed care…

Abstract

In this paper, I review the many research contributions that have advanced our knowledge about the role and impact of physician executives during the recent era of managed care. The interpretive framework for this review is guided by Freidson's restructuring thesis, which posits that physician executives — the administrative elite of the medical profession — represent the segments of the profession whose role will be to balance the needs of the organization with the desires of the medical profession. Although substantial research supports the proposition that physician executives are well positioned, prepared, and willing to undertake such boundary-spanning responsibilities, there is only minimal research specifically addressing the effectiveness of this hybrid profession. In this void, I suggest that another approach to assessing effectiveness is to focus on the process of trust building and maintenance, since trust is central to achieving the primary responsibilities of physician executives. A model of the process of trust development is presented as a guide for future research, along with discussion about particular challenges to physician executives in gaining trust from clinicians and non-physicians.

Details

Advances in Health Care Management
Type: Book
ISBN: 978-1-84950-112-5

Book part
Publication date: 16 October 2014

Sarah Lewis, Joan Bloom, Jennifer Rice, Arash Naeim and Stephen Shortell

This study sought to identify the organizational factors associated with team and network effectiveness of the Athena Breast Health Network, a multi-site collaboration between…

Abstract

Purpose

This study sought to identify the organizational factors associated with team and network effectiveness of the Athena Breast Health Network, a multi-site collaboration between five University of California health systems.

Design/methodology/approach

Providers, managers, and support staff completed self-administered surveys over three years. Statistical analyses at the network and medical center levels tested hypotheses regarding the correlates of effective teams and perceived network effectiveness over time.

Findings

Perceived team effectiveness was positively correlated with group culture and environments which support collaboration, negatively correlated with hierarchical culture, and negatively associated with professional tenure at year two. As measured by increasing team effectiveness scores over time and Athena’s potential impact on patient care, perceived network effectiveness was positively associated with team effectiveness.

Research limitations/implications

Results do not allow us to conclude that a certain type of culture “causes” team effectiveness or that team effectiveness “causes” greater perceptions of progress over time. Subsequent studies should examine these variables simultaneously. Further research is needed to examine the role of payment incentives, internal reward systems, the use of electronic health records, public disclosure of performance data, and depth of leadership within each organization and within the network overall.

Practical implications

Focusing on group affiliation and participation may improve team member perceptions regarding effectiveness and impact on patient care.

Originality/value

Relatively little is known about the adaptive processes that occur within inter-organizational networks to achieve desired goals, and particularly the roles played by multi-disciplinary inter-professional teams. We studied a network comprising multiple campuses actively involved in better understanding, preventing, and treating a complex disease.

Details

Population Health Management in Health Care Organizations
Type: Book
ISBN: 978-1-78441-197-8

Keywords

Book part
Publication date: 27 September 2021

Isabella Bertolini

A Memorandum of Understanding (MoU) was uncovered in January 2017 detailing the sharing of patient data from NHS Digital to the Home Office. It signified a deepening of the…

Abstract

A Memorandum of Understanding (MoU) was uncovered in January 2017 detailing the sharing of patient data from NHS Digital to the Home Office. It signified a deepening of the hostile environment’s presence in the NHS, and was comprehensively rejected by medical professionals. In November 2018, following extensive action calling for its removal, the MoU was withdrawn. This chapter explores how three factors: the lack of legal basis, wide reaching effects, and ethical conflicts of the MoU led to the success of this action, and aims to apply these lessons to other areas of hostile environment policy. It will be established that ethics proved the most influential factor in inciting the opposition, however, all factors may have been integral to the overall success. It shall be demonstrated that, although the success of this action promises much with regards to charging policy, it may be of limited applicability to other areas of the hostile environment.

Details

Privatisation of Migration Control: Power without Accountability?
Type: Book
ISBN: 978-1-80117-663-7

Keywords

Book part
Publication date: 1 January 2013

Vanessa Pouthier, Christopher W.J. Steele and William Ocasio

Institutional logics and collective identities are closely intertwined: logics shape the emergence and evolution of identities, which in turn play a crucial role in mediating the…

Abstract

Institutional logics and collective identities are closely intertwined: logics shape the emergence and evolution of identities, which in turn play a crucial role in mediating the influence of the logics themselves. Though there exists a significant body of research on the intersection of the two phenomena, relatively little attention has been given to changes in the strength, content, and permanence of particular logic–identity associations. In this paper we explore empirically the question of whether and how a logic and identity may become severed, through an inductive case study of the development of the hospitalist identity in health care in the United States. Based on this study, we propose a set of mechanisms through which the distancing of a logic and an identity may occur. We also discuss potential counterfactual outcomes, in order to build theory regarding the longitudinal relationship between logics and identities.

Details

Institutional Logics in Action, Part A
Type: Book
ISBN:

Book part
Publication date: 6 December 2007

Ryan L. Mutter and Michael D. Rosko

There were 4,919 registered, short-term, community hospitals in the 2004 American Hospital Association (AHA) Annual Survey of Hospitals; 60 percent of those hospitals were…

Abstract

There were 4,919 registered, short-term, community hospitals in the 2004 American Hospital Association (AHA) Annual Survey of Hospitals; 60 percent of those hospitals were non-profit (NP), 23 percent of them were public (non-federal government owned and operated), and 17 percent were for-profit (FP). In general, while the absolute number of hospitals in the United States has decreased in recent years, the share of hospitals that are FP has increased. For example, in 1997, the AHA reported 5,057 registered, short-term, community hospitals, of which 59 percent were NP, 25 percent were public, and 16 percent were FP.

Details

Evaluating Hospital Policy and Performance: Contributions from Hospital Policy and Productivity Research
Type: Book
ISBN: 978-0-7623-1453-9

Book part
Publication date: 24 January 2022

Sevilay Ece Gümüş Özuyar

Introduction − Covid-19, which first emerged in Wuhan, People’s Republic of China, in January 2020, with an unknown source, spread to all countries of the world very quickly and…

Abstract

Introduction − Covid-19, which first emerged in Wuhan, People’s Republic of China, in January 2020, with an unknown source, spread to all countries of the world very quickly and caused the death of over two million people world-wide. This ever-increasing global need for health care has created a radical transformation in terms of not only in health care, but also in all public services. Transportation services for the transfer of patients to health institutions, education services due to the dangers of face-to-face training, justice services due to the postponement of non-urgent court proceedings, security services in terms of restriction sanctions and all public services in general due to the disruption of access to public services due to flexible working hours applied to public personnel has entered into an unplanned provision.

Purpose: The aim of this chapter is to identify the problems that arise in the provision of public goods and services due to the global epidemic of Covid-19, and to bring a new interpretation to the theoretical discussions about the optimal delivery level of public services when there is a situation of communicable disease.

Methodology: The principles of public goods and service provision of G20 countries, Covid-19 mortality rates, indicators of the well-being of healthcare delivery such as the number of bed and personnel, the type and number of devices used to diagnose the Covid disease, and the public service restrictions taken to eliminate Covid-19, have been evaluated by employing descriptive analysis. In order to prevent income and advanced levels from becoming distinctive features, G20 countries with similar income and development levels were selected for this research.

Findings: Due to the Covid-19 pandemic, there has been a distortion in the preference of provision of almost all public goods, and it has been observed that the delivery level of public services affects each other since all are linked like a chain. Failure to achieve what is expected from international organizations, which should be in a regulatory position in this regard, has increased concerns about the optimal presentation level of all public goods, especially health, in the future. As long as there is a global pandemic and countries do not take effective measures, a bad second best position that is far from optimal results but provides that instant solutions.

Details

Insurance and Risk Management for Disruptions in Social, Economic and Environmental Systems: Decision and Control Allocations within New Domains of Risk
Type: Book
ISBN: 978-1-80117-140-3

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