Tracking the changing provider landscape: implications for health policy and practice

Area of Science:

• Health services research
• Healthcare management
• Organizational studies

Background:

• The 1990s saw significant interest in developing organized delivery systems (ODS) within healthcare.
• Industry observers later raised questions about the efficacy and sustainability of these integrated healthcare models.

Purpose of the Study:

• To investigate nationwide trends in the centralization of health networks and systems during the 1990s.
• To determine if healthcare organizations were moving away from the vertical and horizontal integration central to ODS.

Main Methods:

• Utilized an established taxonomy to classify health networks and systems.
• Analyzed organizational structures of healthcare providers between 1994 and 1998.
• Examined changes in hospital services, physician arrangements, and insurance product development.

Main Results:

• Both health networks and systems demonstrated decreased centralization in hospital services.
• Physician arrangements and insurance product development also showed trends toward less centralization.
• No universal trend towards disintegration was observed, suggesting diverse organizational strategies.

Conclusions:

• Healthcare organizations exhibited significant experimentation in organizational forms during the study period.
• The move away from highly centralized structures suggests a dynamic evolution rather than a simple collapse of organized delivery systems.