A taxonomy of health networks and systems: bringing order out of chaos.

摘要: Abstract OBJECTIVE: To use existing theory and data for empirical development of a taxonomy that identifies clusters organizations sharing common strategic/structural features. DATA SOURCES: Data from the 1994 1995 American Hospital Association Annual Surveys, which provide extensive on hospital involvement in hospital-led health networks systems. STUDY DESIGN: Theories organization behavior industrial economics were used to identify three dimensions: differentiation, refers number different products/services along healthcare continuum; integration, mechanisms achieve unity effort across organizational components; centralization, relates extent activities take place at centralized versus dispersed locations. These dimensions applied components service/product continuum: services, physician arrangements, provider-based insurance activities. EXTRACTION METHODS: We identified 295 systems 274 United States 1994, 297 306 using AHA data. Empirical measures aggregated individual network system level. PRINCIPAL FINDINGS: reliable, internally valid, stable four-cluster solution five-cluster found differentiation centralization particularly important distinguishing unique organizations. High typically occurred with low suggests broader scope activity is more difficult centrally coordinate. Integration was also important, but we engaged both ownership-based contractual-based integration or they not integrated all. CONCLUSIONS: Overall, able classify approximately 70 percent 90 into well-defined clusters. Given widespread perception change has been chaotic, our research meaningful similarities exist many evolving The resulting provides new lexicon researchers, policymakers, executives characterizing key strategic structural features framework future inquiry about relationships between strategy, structure, performance, assessing policy issues, such as Medicare Provider Sponsored Organizations, antitrust, regulation.