Hospital competition in major U.S. metropolitan areas: empirical evidence.

In response to dramatic rises in health care costs, policy-makers have been debating the relative merits of competitive strategies as a means of containing costs. This article represents a study of the 29 largest MSAs for 1991. Controlling for environmental conditions in each market, the impact of competition on hospital costs was examined. Competition was found to have had a significant positive impact on overall hospital costs.

Diversification strategy and performance: implications for health services research.

Health care represents a promising area of research due to its uniqueness. In recent years, considerable progress has been made in diversification strategy and performance research but not the study of health services strategy research. This article reviews diversification strategy and performance in health services domains. Adopting Datta, Rajagopalan, and Rasheed's (1991) framework, the authors evaluate the theoretical and empirical contributions of this research. The limitations and theoretical implications of these efforts are also explored.

Medicare risk contracting: analyzing managed care for the aging population in the USA.

This paper focuses on Medicare risk contracting in the USA. The issue of the current method of reimbursement versus Medicare risk contracting is explored. Risk sharing and payment mechanisms are described and analyzed. The strengths and weaknesses (score-card) of Medicare beneficiaries entering HMOs are reviewed. Finally, the issue of selection bias in Medicare HMOs is discussed regarding future implementation strategy.

The effects of organizational structure on hospital performance.

The relationship between organizational structure and organizational performance would seem at first to be straightforward and obvious. The more complex organizational structures will result in positive organizational performance (i.e. greater effectiveness or profitability). The premise is that the ability of an organization to achieve its mission successfully should be a result of the organizational structure. It is generally accepted that certain structural configurations are able to achieve certain goals better than others (i.e. a diversified structure as opposed to a simple structure). The research to date indicates that this is not necessarily true. The specific issue examined in this paper will be the effect of structural diversification on performance in industry and healthcare.

The predictors of quality care.

Patients' perceptions of quality are important to the performance ratings, financial viability, and operational options afforded to purchasers of health care. Through TRICARE, the Department of Defense provides care for the more than 1.5 million active duty service members charged with the defense of the nation. As patients, these service members are typically incapable of assessing the technical quality of the care they receive. This study examines the attributes of health care delivery that define military patients' perceptions of quality and discusses the implications of these assessments.

Retiree health benefits revisited.

A review of the current literature on retiree health benefits finds that supplemental coverage for the majority of Medicare beneficiaries is in the form of employer-provided coverage. Findings in current literature also suggest that Medicare risk contracts can contain costs but efforts must be made to provide quality information to Medicare beneficiaries in order to increase enrollment in HMOs. Finally, a linear relationship is implied between income and the probability of supplementary insurance ownership.

Organizational power and conflict regarding the hospital-physician relationship: symbolic or substantive?

The purpose of this paper is to provide a critical review of organizational power and conflict regarding the hospital-physician relationship. The issue of power being symbolic and/or substantive is discussed. The classification (Mintzberg Model) of organizations as simple structures, machine bureaucracies, professional bureaucracies, divisionalized forms and adhocracies are reviewed. Also, the issue of whether the perceived autonomy that professional employees enjoy increases the likelihood that an executive level manager in a professional bureaucracy (hospital entity) will devote substantial attention to influencing symbolic outcomes as opposed to substantive outcomes in a machine bureaucracy is discussed. In conclusion, conflicts between hospitals and physicians can be resolved in two ways: (1) by avoiding controversial decisions that might threaten the powers and prerogatives of professional groups; and (2) by agreeing to decisions that hold something for everyone involved in the hospital-physician power relationship.

Retiree health benefits in the United States: a strategic critical management review.

This article provides a critical review of studies associated with retiree health benefits in the United States. An attempt is made to determine if logical conclusions or trends could be identified regarding this issue of health care policy debate. The forms of retiree health benefits are covered, as is a discussion of Medigap policies and insurance coverage for the elderly. Employer-sponsored retiree benefits and the effects of supplemental coverage on the use of services are also reviewed. Lastly, a discussion and conclusion regarding this research agenda is presented with a critical analysis of the health care policy management debate for the future.

Ambulatory patient groups and redefining the roles of health care providers' delivery services in the USA.

Provides a review and analysis of the ambulatory patient groups classification system. Discusses a review of the history, development and implementation process. Concludes that in the ongoing efforts to move towards full-managed care in the not-so-distant future, ambulatory patients groups are another potential cost-cutting remedy for current health care providers and that future research into this issue is a must for public policy makers.

The evolution of quality in the US health care industry: an old wine in a new bottle.

Explores the evolution of the quality issue within the health-care industry and also the significance of quality in the health industry along with the historical origins of quality management. Reviews applications of total quality management in the health care industry along with implementation issues. Concludes that a fundamental understanding of the process of total quality management is an absolute requirement.

Medicare health maintenance organizations. An industry analysis for the elderly in the USA.

Provides a review and analysis of Medicare health maintenance organizations in the USA. The Porter model of industry structure is used. Discusses the issues of suppliers, buyers, market entry and substitutes. Indicates there is currently no intense rivalry among Medicare risk-based HMOs. However, the Porter model reveals crucial information regarding the forces which drive industry competition. Trends in the field of managed care and Medicare financing continue to be a real challenge regarding future research.

The uninsured in the United States: a strategic critical management review.

The purpose of this article is to provide a critical review on studies of access and utilization of the uninsured, and some related proposals regarding the health care reform debate. Also, an attempt is made to determine if conclusions or trends can be identified to develop the groundwork for effective policy initiatives to assure access to the 37 million uninsured persons in the United States.

Nurse practitioners in the USA--their past, present and future: some implications for the health care management delivery system.

Chronicles the role of nurse practitioners from their early beginnings to the present. Not only examines this group's history but also explores their present role in health care delivery. Discusses interprofessional relationships along with consumer perceptions of their function. Concludes with an analysis of the issues facing nurse practitioners and future implications for their viability.

The effect of financial incentives on physicians' behaviour in health maintenance organizations.

Examines the relationship between the presence of financial incentives and their effect on physician behavior in health maintenance organizations (HMOs). By reviewing the scope and dimensions of both HMOs and financial incentives, a foundation is laid for the review of the current empirical evidence. Further analysis and conceptual development is given to this topic by stating the limitations of existing research--in the confounding variables, in the complexity of incentives, and in the unanswered questions of quality of care--and by proposing innovative ways of studying the ¿other aspects of physician behavior' not previously considered. Questions and implications are raised for future research and practice.

The effects of advanced information technology on organizational design.

Illustrates several issues associated with the effects of advanced information technology on the organizational design function. Explores the relationship between technology and organizational design. Cites some early empirical studies and identifies with some contemporary challenges. Also mentions implications for new organizational forms within the context of a realigned health-care industry perspective. Concludes that organizational theorists and information systems scholars must integrate their efforts in order to appreciate the changes within this field of management theory, thought and practice.

Employer-employee based quality circles in Japan: human resource policy implications for American firms.

This paper traces the development of the quality circle in Japan with reference to such traditions as permanent employment, nenko (seniority-based compensation), enterprise unionism, and management paternalism. Quality circles are examined as tools for motivating employees, reducing labor turnover, effecting employee "career expansion," and allowing employee participation in job redesign.