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The Changing Configuration of Health Organizations: Revisiting the Taxonomy of Health Networks and Systems.

Dubbs NL, Bazzoli GJ, Shortell SM, Kralovec P; Academy for Health Services Research and Health Policy. Meeting.

Abstr Acad Health Serv Res Health Policy Meet. 2001; 18: 124.

Division of Health Policy and Management, Columbia University School of Public Health, 600 West 168th Street - Room 606, New York, NY 10032, Phone: (212) 305-4081, Fax (212) 305-3405, E-mail: nd162@columbia.edu

RESEARCH OBJECTIVE: To validate and refine our taxonomy of health networks and systems (initially created with 1994 data) and assess how the original clusters of hospital-led health services organizations have changed over time.STUDY DESIGN: As in our prior work, we apply 3 strategic/structural dimensions (differentiation, integration, and centralization) to 3 components of the health service/product continuum (hospital services, physician arrangements, and provider-based insurance activities) to identify separate cluster solutions for health networks and health systems.POPULATION STUDIED: Data from the 1998 American Hospital Association Annual Survey are aggregated from the individual hospital-level to the network- or system-level yielding 216 health networks and 342 health systems for analysis.PRINCIPAL FINDINGS: The empirical analysis of 1998 data suggests a 4 cluster solution for networks and a 5 cluster solution for systems, which parallels the findings for our original 1994 analysis. Cluster descriptions, while reminiscent of the original taxonomy, have discernible distinctions. For networks, we identify: 134 independent hospital networks (characterized by a lack of vertical relationships among network components); 35 decentralized health networks (typified by decentralized hospital, physician, and insurance activity); 24 centralized hospital services health networks (distinguished by highly centralized hospital services but moderate degrees of network-level physician and insurance centralization); and 23 centralized physician/insurance health networks (defined by high levels of centralization in physician and insurance domains but largely decentralized hospital services). For systems, we find: 45 independent hospital systems (characterized by a lack of vertical relationships among system components); 36 decentralized physician/insurance health systems (featuring high degrees of hospital-level physician and insurance arrangements); 10 decentralized health systems (presenting low to moderate system-level centralization across product/service dimensions); 139 moderately centralized health systems (exhibiting moderate levels of centralization across product/service dimensions); and 112 centralized health systems (displaying consistently high degrees of centralization across product/service dimensions).CONCLUSIONS: Differentiation, integration, and centralization of service-mix, physician arrangements, and insurance domains remain useful parameters for classifying health networks and systems. The cluster categories that emerge are recognizable from the original taxonomy, however, they reveal that some new organizational configurations have become dominant. For the health networks, the results suggest that independent hospital networks and decentralized organizational forms persist, but that centralization of product/service lines is occurring more selectively than in the past. For health systems, centralized, moderately centralized, and independent hospital system forms remain common, but there is increased diversity in decentralized organizational forms.IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: The Changing Configuration of Health Organizations: Revisiting the Taxonomy of Health Networks and Systems.

Publication Types:
  • Meeting Abstracts
Keywords:
  • American Hospital Association
  • Centralized Hospital Services
  • Cluster Analysis
  • Data Collection
  • Delivery of Health Care, Integrated
  • Health
  • Health Services Research
  • Hospital Administration
  • Hospitals
  • classification
  • hsrmtgs
Other ID:
  • GWHSR0001727
UI: 102273403

From Meeting Abstracts




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