Alexander J A, Waters T M, Burns L R, Shortell S M, Gillies R R, Budetti P P, Zuckerman H S
Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor 48109, USA.
Med Care. 2001 Jul;39(7 Suppl 1):I30-45.
To examine the association between the degree of alignment between physicians and health care systems, and interorganizational linkages between physician groups and health care systems.
The study used a cross sectional, comparative analysis using a sample of 1,279 physicians practicing in loosely affiliated arrangements and 1,781 physicians in 61 groups closely affiliated with 14 vertically integrated health systems. Measures of physician alignment were based on multiitem scales validated in previous studies and derived from surveys sent to individual physicians. Measures of interorganizational linkages were specified at the institutional, administrative, and technical core levels of the physician group and were developed from surveys sent to the administrator of each of the 61 physician groups in the sample. Two stage Heckman models with fixed effects adjustments in the second stage were used to correct for sample selection and clustering respectively.
After accounting for sample selection, fixed effects, and group and individual controls, physicians in groups with more valued practice service linkages display consistently higher alignment with systems than physicians in groups that have fewer such linkages. Results also suggest that centralized administrative control lowers physician-system alignment for selected measures of alignment. Governance interlocks exhibited only weak associations with alignment.
Our findings suggest that alignment generally follows resource exchanges that promote value-added contributions to physicians and physician groups while preserving control and authority within the group.
研究医生与医疗保健系统之间的契合程度，以及医生群体与医疗保健系统之间的组织间联系。
本研究采用横断面比较分析，样本包括1279名以松散附属安排执业的医生和1781名隶属于14个垂直整合医疗系统的61个紧密附属医生群体中的医生。医生契合度的衡量基于先前研究中验证过的多项目量表，该量表来自向个体医生发放的调查问卷。组织间联系的衡量指标在医生群体的机构、行政和技术核心层面进行设定，来自向样本中61个医生群体的管理人员发放的调查问卷。第二阶段采用带有固定效应调整的两阶段赫克曼模型分别校正样本选择和聚类问题。
在考虑样本选择、固定效应以及群体和个体控制因素后，与实践服务联系较少的群体中的医生相比，具有更有价值的实践服务联系的群体中的医生与系统的契合度始终更高。结果还表明，对于选定的契合度衡量指标，集中行政控制会降低医生与系统的契合度。治理连锁与契合度仅呈现微弱关联。
我们的研究结果表明，契合度通常遵循资源交换模式，这种交换在促进对医生和医生群体的增值贡献的同时，保持了群体内部的控制权和权威。
