Erasmus University Rotterdam, Rotterdam, The Netherlands.
Dutch Health and Youth Care Inspectorate, Utrecht, The Netherlands.
Int J Health Plann Manage. 2023 Nov;38(6):1721-1742. doi: 10.1002/hpm.3695. Epub 2023 Aug 6.
Across OECD countries, integration between healthcare organisations has become an indispensable part of contemporary healthcare provision. In recent years, inter-organisational collaboration has increasingly been encouraged in health and competition policy at the expense of mergers. Yet, understanding of whether healthcare organisations make an active choice between merging and collaborating is lacking. Hence, this study systematically examines (i) healthcare executives' motives for integration, (ii) their potential trade-offs between collaborating or merging, and (iii) the barriers to collaborating perceived by them.
Early 2019, an online questionnaire was conducted among a nationwide panel of 714 healthcare executives in the Netherlands. Because of their strategic position within healthcare organisations as end-responsible managers, healthcare executives are especially suited to provide broad and in-depth knowledge on the internal and external processes and decisions. Three hundred thirty-seven Dutch healthcare executives completed the questionnaire (response rate 47%). This study sample was representative of the largest healthcare sectors in the Netherlands. In total, 137 mergers and 235 inter-organisational collaborations were reported. Both closed questions and open-ended questions were systematically analysed.
Improving or broadening healthcare provision is the foremost motive for mergers as well as inter-organisational collaborations. When considering both types, reducing governance complexity is one of the decisive reasons to opt for a merger, whereas aversion towards a full merger and lack of support base within the own organisation convinced healthcare executives to choose for a collaboration. When comparing specific healthcare sectors, the overlap in pursued motives and sub-motives indicates that inter-organisational collaborations and mergers are used for comparable objectives. Only a small minority of the responding executives switched between both types of integration. Institutional barriers, such as laws, regulations and financing regimes, appear to be the most restricting for healthcare executives to engage in inter-organisational collaborations.
Our integral approach and systematic comparison across sectors could serve policymakers, regulators and healthcare providers in aligning organisational objectives and societal objectives in decision-making on collaborations and mergers. Future research is recommended to study multiple collaboration and merger cases qualitatively for a detailed examination of decision-making by healthcare executives, and develop an integral assessment framework for balancing collaborations and mergers based on their effects in the medium to long term.
在经合组织国家，医疗机构之间的整合已成为当代医疗服务不可或缺的一部分。近年来，在卫生和竞争政策方面，越来越鼓励组织间的合作，而不是合并。然而，对于医疗机构在合并和合作之间是否会做出主动选择，人们的理解还很缺乏。因此，本研究系统地考察了（i）医疗保健高管进行整合的动机，（ii）他们在合作或合并之间进行权衡取舍的潜在因素，以及（iii）他们认为合作面临的障碍。
2019 年初，在荷兰全国范围内的一个由 714 名医疗保健高管组成的小组中进行了在线问卷调查。由于他们在医疗机构中的战略地位，作为最终负责的管理者，医疗保健高管尤其适合提供广泛而深入的关于内部和外部流程和决策的知识。337 名荷兰医疗保健高管完成了问卷调查（回应率为 47%）。该研究样本代表了荷兰最大的医疗保健部门。总共报告了 137 起合并和 235 起组织间合作。系统地分析了封闭式问题和开放式问题。
改善或拓宽医疗服务是合并以及组织间合作的首要动机。在考虑这两种类型时，降低治理复杂性是选择合并的决定性原因之一，而对完全合并的反感以及组织内部缺乏支持基础，使医疗保健高管选择了合作。在比较特定的医疗保健部门时，所追求的动机和子动机的重叠表明，组织间合作和合并是为了类似的目标而进行的。只有一小部分回应的高管在这两种类型的整合之间进行了转换。机构障碍，如法律、法规和融资制度，似乎对医疗保健高管参与组织间合作的限制最大。
我们的整体方法和跨部门的系统比较，可以为政策制定者、监管机构和医疗服务提供者提供服务，使他们能够在合作和合并的决策中使组织目标与社会目标保持一致。建议进行未来的研究，对多个合作和合并案例进行定性研究，以详细考察医疗保健高管的决策，并基于中长期效果制定一个综合的合作和合并评估框架。
