Access

You are not currently logged in.

Access your personal account or get JSTOR access through your library or other institution:

login

Log in to your personal account or through your institution.

A Theory of Physician-Hospital Integration: Contending Institutional and Market Logics in the Health Care Field

Thomas G. Rundall, Stephen M. Shortell and Jeffrey A. Alexander
Journal of Health and Social Behavior
Vol. 45, Extra Issue: Health and Health Care in the United States: Origins and Dynamics (2004), pp. 102-117
Stable URL: http://www.jstor.org/stable/3653827
Page Count: 16
  • Download ($14.00)
  • Subscribe ($19.50)
  • Cite this Item
A Theory of Physician-Hospital Integration: Contending Institutional and Market Logics in the Health Care Field
Preview not available

Abstract

This article proposes a theory of physician-hospital integration. The theory is developed by building on three streams of scholarship: "new" institutionalism, "old" institutionalism, and the theory of economic markets. The theory uses several key concepts from these theoretical frameworks, including the notions of environmental demands for legitimacy, market demands for efficiency, and agency. To enhance the predictive power of the theory, two new concepts are introduced: directionality of influence between institutional and market forces at the macro-societal level, and degree of separation of institutional and market domains at the local level-which add important predictive power to the theory. Using these concepts, a number of hypotheses are proposed regarding the ideal types of physician-hospital arrangements that are likely to emerge under different combinations of directionality of influence and institutional and market domain separation. Moreover, the theory generates hypotheses regarding organizational dynamics associated with physician-hospital integration, including the conditions associated with high and low prevalence of physician-hospital integration, the extent to which the integrated organization is physician-centric or hospital-centric, and whether physician-hospital integration is likely to be based on loose contractual arrangements or tight, ownership-based arrangements.

Page Thumbnails

  • Thumbnail: Page 
102
    102
  • Thumbnail: Page 
103
    103
  • Thumbnail: Page 
104
    104
  • Thumbnail: Page 
105
    105
  • Thumbnail: Page 
106
    106
  • Thumbnail: Page 
107
    107
  • Thumbnail: Page 
108
    108
  • Thumbnail: Page 
109
    109
  • Thumbnail: Page 
110
    110
  • Thumbnail: Page 
111
    111
  • Thumbnail: Page 
112
    112
  • Thumbnail: Page 
113
    113
  • Thumbnail: Page 
114
    114
  • Thumbnail: Page 
115
    115
  • Thumbnail: Page 
116
    116
  • Thumbnail: Page 
117
    117