Burns L R
Department of Health Care Systems, Wharton School, University of Pennsylvania, Philadelphia, USA.
J Healthc Manag. 1999 Jan-Feb;44(1):14-31; discussion 31-3.
Integrated health systems are confronted with numerous dilemmas that must be managed. Many of these dilemmas are an inherent part of the system's structure, given that multiple competing hospitals, medical groups, and (sometimes) health plans are often under one organizational roof. This article presents an analysis of these dilemmas--referred to in the management literature as polarities--as they are found in six integrated health systems in Illinois. The nine polarities that must be managed include (1) hospital systems that want to be organizations of physicians; (2) system expansion by growing the physician component; (3) system centralization and physician decentralization; (4) centripetal and centrifugal forces involving physicians; (5) system objectives and physician interests; (6) system centralization and hospital decentralization; (7) primary care physicians and specialists; (8) physician autonomy via collectivization; and (9) vertical and virtual integration. The article identifies some of the solutions to the polarities that have been enacted by systems. In general, executives and physicians in integrated health systems must attend to the processes of integration as much as or more than the structures of integration.
整合型医疗系统面临着众多必须加以应对的困境。鉴于多个相互竞争的医院、医疗集团以及（有时）健康计划常常隶属于同一个组织架构，其中许多困境是该系统结构中固有的一部分。本文对在伊利诺伊州的六个整合型医疗系统中发现的这些困境——在管理文献中被称为两极对立——进行了分析。必须加以应对的九个两极对立情况包括：（1）希望成为医师组织的医院系统；（2）通过增加医师组成部分来实现系统扩张；（3）系统集中化与医师分散化；（4）涉及医师的向心力和离心力；（5）系统目标与医师利益；（6）系统集中化与医院分散化；（7）初级保健医师与专科医师；（8）通过集体化实现医师自主权；以及（9）垂直整合与虚拟整合。本文确定了各系统针对这些两极对立情况所采取的一些解决办法。总体而言，整合型医疗系统中的管理人员和医师必须同样关注或更加关注整合过程，而非仅仅关注整合结构。
