Physicians and hospitals are pioneering new and more coordinated organizational forms under pressure from market competition. Arms-length "doctor's workshop" relationships are yielding to integrated delivery systems and contractual delivery networks. This article analyzes organizational change in health care through the conceptual lens of institutional economics, defined broadly as including agency theory, transactions cost economics, and the dynamic capabilities view of the firm. These theoretical frameworks highlight three distinct functions of organization under managed care: coordination, governance, and innovation.
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References
1.
Advisory Board . 1993. The Grand Alliance: Vertical Integration Strategies for Physicians and Health Systems. Washington, DC: Advisory Board.
2.
American Hospital Association . 1994. Hospital Statistics: The AHA Profile of United States Hospitals. Chicago: American Hospital Association.
3.
Alchian, A. A. , and H. Demsetz. 1972. Production, Information Costs, and Economic Organization. American Economic Review62 (5):777-795.
4.
Arrow, K. J.1963. Uncertainty and the Welfare Economics of Medical Care. American Economic Review53 (5):941-973.
5.
Barnard, C. I.1938. The Functions of the Executive. Cambridge, MA: Harvard University Press.
6.
Barney, J. B.1986. Strategic Factor Markets: Expectations, Luck, and Business Strategy. Management Science32 (10):1231-1241.
7.
Chandler, A. D.1962. Strategy and Structure: Chapters in the History of the Industrial Enterprise. Cambridge: MIT Press.
8.
Chandler, A. D.1990. Scale and Scope: The Dynamics of Industrial Capitalism. Cambridge, MA: Belknap.
9.
Coase, R. H.1937. The Nature of the Firm. Economica4:386-405.
10.
Dierickx, I. , and K. Cool. 1989. Asset Stock Accumulation and Sustainability of Competitive Advantage. Management Science35 (12):1504-1511.
11.
Dosi, G.1988. Sources, Procedures, and Microeconomic Effects of Innovation. Journal of Economic Literature26 (September):1120-1171.
12.
Eisenhardt, K. M.1989. Agency Theory: An Assessment and Review. Academy of Management Review14 (1):57-74.
13.
Fama, E. F.1980. Agency Problems and the Theory of the Firm. Journal of Political Economy88 (2):288-307.
14.
Fama, E. F. , and M. C. Jensen. 1983. Agency Problems and Residual Claims. Journal of Law and Economics26 (June):327-349.
15.
Freidson, E.1970. Profession of Medicine: A Study of the Sociology of Applied Knowledge. New York: Dodd, Mead & Co.
16.
Jensen, M. C.1986. Agency Costs of Free Cash Flow, Corporate Finance, and Takeovers. American Economic Review76 (2):323-329.
17.
Jensen, M. C.1989. Eclipse of the Public Corporation. Harvard Business Review, September/October 61-74.
18.
Jensen, M. C. , and W. H. Meckling. 1976. Theory of the Firm: Managerial Behavior, Agency Costs and Ownership Structure. Journal of Financial Economics3:305-360.
19.
Jonas, N.1986. The Hollow Corporation. Business Week, March 3, 57-59.
20.
Joskow, P. L.1980. The Effect of Competition and Regulation on Hospital Bed Supply and the Reservation Quality of the Hospital. Bell Journal of Economics11 (2):421-447.
21.
Milgrom, P. R.1988. Employment Contracts, Influence Activities, and Efficient Organization Design. Journal of Political Economy96 (1):42-60.
22.
Nelson, R. R.1990. Capitalism as an Engine of Progress. Research Policy19:193-214.
23.
Nelson, R. R.1991. Why Do Firms Differ, and How Does It Matter?Strategic Management Journal12:61-74.
24.
Nelson, R. R. , and S. G. Winter. 1982. An Evolutionary Theory of Economic Change. Cambridge, MA: Harvard University Press.
25.
Panzar, J. C. , and R. D. Willig. 1981. Sustainability Analysis: Economies of Scope. American Economic Review71 (2):268-272.
26.
Parsons, T.1952. The Social System. London: Tavistock.
27.
Pauly, M. , and M. Redisch. 1973. The Not-for-Profit Hospital as a Physicians Cooperative. American Economic Review63 (March):87-99.
28.
Penrose, E.1959. The Theory of Growth of the Firm. New York: John Wiley.
29.
Powell, W. W.1990. Neither Market nor Hierarchy: Network Forms of Organization. In Research in Organizational Behavior;295-336. Greenwich, CT: JAI.
30.
Robinson, J. C.1988. Hospital Quality Competition and the Economics of Imperfect Information. Milbank Quarterly66 (3):465-481.
31.
Robinson, J. C.1994. The Changing Boundaries of the American Hospital. Milbank Quarterly72 (2):259-275.
32.
Robinson, J. C.1996. Decline of Hospital Utilization and Cost Inflation under Managed Care in California. Journal of the American Medical Association276 (13):1060-1064.
33.
Robinson, J. C. , and L. C. Casalino. 1995. The Growth of Medical Groups Paid through Capitation in California. New England Journal of Medicine333:1684-1687.
34.
Robinson, J. C. , and L. C. Casalino. 1996. Vertical Integration and Organizational Networks in Health Care. Health Affairs15 (1):7-22.
35.
Robinson, J. C. , D. W. Garnick, and S. J. McPhee. 1987. Market and Regulatory Influences on the Availability of Coronary Angioplasty and Bypass Surgery in the U.S. Hospitals. New England Journal of Medicine317:85-90.
36.
Robinson, J. C. , and H. S. Luft. 1985. The Impact of Hospital Market Structure on Patient Volume, Average Length of Stay, and the Cost of Care. Journal of Health Economics4:333-356.
37.
Roemer, M. I. , and J. W. Friedman. 1971. Doctors in Hospitals: Medical Staff Organization and Hospital Performance. Baltimore, MD: The Johns Hopkins University Press.
38.
Rumelt, R. P.1991. How Much Does Industry Matter?Strategic Management Journal12:167-185.
39.
Sappington, D. E.1991. Incentives in Principal-Agent Relationships. Journal of Economic Perspectives5 (2):45-66.
40.
Schumpeter, J. A.1942. Capitalism, Socialism, and Democracy. New York: Harper & Row.
41.
Shortell, S. M. , R. R. Gillies, and K. J. Devers. 1995. Reinventing the American Hospital. The Milbank Quarterly73 (2):131-160.
42.
Simon, H. A.1945. Administrative Behavior. New York: Macmillan.
43.
Starr, P.1982. The Social Transformation of American Medicine. New York: Basic Books.
44.
Stevens, R.1989. In Sickness and in Wealth. New York: Basic Books.
45.
Stiglitz, J. E.1987. The Causes and Consequences of the Dependence of Quality on Price. Journal of Economic Literature25 (1):1-48.
46.
Teece, D. J.1980. Economies of Scope and the Scope of the Enterprise. Journal of Economic Behavior and Organization1 (3):223-247.
47.
Teece, D. J.1986. Profiting from Technological Innovation: Implications for Integration, Collaboration, Licensing, and Public Policy. Research Policy15:285-305.
48.
Teece, D. J.1993. The Dynamics of Industrial Capitalism: Perspectives on Alfred Chandler's Scale and Scope. Journal of Economic Literature31:199-225.
49.
Weber, M.1978. Economy and Society: An Outline of Interpretive Sociology. Berkeley: University of California Press.
50.
Williamson, O. E.1985. The Economic Institutions of Capitalism. New York: Free Press.
51.
Williamson, O. E.1989. Transaction of Cost Economics. In Handbook of Industrial Organization, ed. R. Schmalensee and R. D. Willig; 136-178. New York: Elsevier.
52.
Williamson, O. E.1991. Comparative Economic Organization: The Analysis of Discrete Structural Alternatives. Administrative Science Quarterly36 (June):269-296.
53.
Willig, R. D.1979. Multiproduct Technology and Market Structure. American Economic Review69 (2):346-351.
54.
Young, A.1993. Invention and Bounded Learning by Doing. Journal of Political Economy101 (3):443-472.
