Tracking The Changing Provider Landscape: Implications For Health Policy And Practice

Authors:
  • SSStephen M. Shortell
    Stephen M. Shortell
  • FCFederico Ciliberto
    Federico Ciliberto
  • PKPeter D. Kralovec
    Peter D. Kralovec
  • NDNicole L. Dubbs
    Nicole L. Dubbs
  • JHJill R. Horwitz
    Jill R. Horwitz
  • LBLawton R. Burns
    Lawton R. Burns
  • MPMark V. Pauly
    Mark V. Pauly
  • FSFrank A. Sloan
    Frank A. Sloan
  • RVRobert A. Vraciu
    Robert A. Vraciu
  • MNMary D. Naylor
    Mary D. Naylor
  • EKEllen T. Kurtzman
    Ellen T. Kurtzman

Abstract
Throughout the 1990s health care providers were interested in developing organized delivery systems. However, industry observers have increasingly questioned the sense of these efforts. Using an established taxonomy of health networks and systems, we examined whether there was a nationwide trend away from the vertical and horizontal arrangements that serve as the backbone to organized delivery systems. Studying 1994–1998, we found that both health networks and systems became less centralized in their hospital services, physician arrangements, and insurance product development. We did not find a general pathway to disintegration but instead found considerable experimentation in organizational form.