Merit pay and incentive compensation systems for physicians and managers.

In Russia, as in all countries, physicians are and will continue to be central actors in health sector reform and in health sector resource allocation decisions. How they are recognized and rewarded for their work will therefore dramatically influence the ultimate success of reforms and health sector expenditure patterns. Much of the debate in Russia and many of the articles in this special edition of the Journal are focused on creative ways to move money from purchasers to provider institutions. There has not been enough discussion nor analysis of how money needs to move within institutions to individual physicians and managers as a means to influence their behavior. A new approach to base and merit pay is needed. This article explores conceptual and practical dimensions of alternate ways to compensate physicians as clinicians and managers. New forms of recognition and types of rewards will be summarized. Managerial skills and systems needed to support such new methods will also be highlighted.

Regional systems face organizational development challenges to integration.

Luke concludes his article by recommending regional system formation be permitted, even encouraged. I certainly agree with that encouragement and also agree that demonstration and evaluation projects should be initiated to determine what works and what does not work in regional system development. At the present time that information is gathered and shared on an ad hoc basis through alliances of systems, such as American Healthcare Systems. Although this ad hoc mechanism is useful, it needs to be supplemented with more research, policy initiatives, and structured evaluations. Luke has made a positive contribution with his national study, and more work of this nature will aid the development of regional systems across the United States.

Consolidation benefits community. Interview by Donald E.L. Johnson.

Multi-unit hospital systems remain one of the important players in health care during the 1990s. But, what model works best for bringing superior care to a community or region? In the following interview with Health Care Strategic Management's Donald E.L. Johnson, Donald C. Wegmiller, President/CEO of Health One, a health care corporation offering services in 12 outlying communities in five states, as well as metropolitan Minneapolis-St. Paul, defines his vision for such a system and the community benefits that hospitals should be providing and measuring.

Management issues in the development and maturation of multihospital systems.

Little has been written about the maturation of multihospital systems and the demands or challenges this process places on system managers. This article reviews particular developmental concerns within the context of a generic life cycle model and discusses the unique management challenges that arise as a system develops and matures.

Looking for a business partner? Shake hands with the medical staff.

During these days of increased competition and dramatic changes in payment systems, pursuing business opportunities in cooperation with local physicians is becoming increasingly important. This articles describes the efforts of Health Central System, Minneapolis, to promote new partnerships with its hospitals' medical staffs at both the local hospital and the corporate level.