Difficulties in consummating a meaningful hospital-physician collaboration

Although there is a vast literature concerning the virtues of hospital-physician collaborative efforts, their actual performance to date in the United States according to rigorous research studies is far less than impressive. Hospitals are usually the party most interested in initiating such alignments, but physicians, as they respond to a patient's clinical needs, control almost all healthcare expenditures. Discussions between the parties have the potential of creating serious conflicts, primarily because of the lack of trust between physicians and hospital executives. The most frequent issues that arise are those relating to the sharing of ambulatory care revenues and who will be responsible for various clinical operations.