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Exchanges Between Healthcare Providers And Insurers: A Case Study

Jane Cote and Claire Latha
Journal of Managerial Issues
Vol. 15, No. 2 (Summer 2003), pp. 191-207
Stable URL: http://www.jstor.org/stable/40604425
Page Count: 17
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Since scans are not currently available to screen readers, please contact JSTOR User Support for access. We'll provide a PDF copy for your screen reader.
Exchanges Between Healthcare Providers And Insurers: A Case Study
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Abstract

Conflicting goals, compounded by escalating healthcare costs, have created frustrations in the healthcare funding system.This article asserts that the healthcare funding system mirrors a distribution channel where substantial coordination is necessary to ensure effective and efficient product or service delivery to the marketplace. The distribution channel research is a rich resource that provides a superior framework in which to interpret the healthcare funding system. Adapting it to the healthcare funding system offers new perspectives in which the system can be analyzed and solutions proposed.The focus in this study is on a single dyad within the distribution channel—the physician and insurance provider.Two complementary research methods are used at one representative physician practice to test the applicability of the channel framework in this setting. Interviews with healthcare administrators demonstrate the correspondence between fundamental variables inherent in the traditional channel partnership and the physician-insurer provider relationship.Using patient level billing records, data were then collected to determine the extent to which environmental characteristics present in traditional channel relationships are present in the physician-insurance provider dyad. The findings support the applicability of the channel framework to the healthcare funding system.

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