Shortell S M, Morrisey M A, Conrad D A
Health Serv Res. 1985 Dec;20(5):597-628.
New forms of payment, growing competition, the continued evolution of multiunit hospital systems, and associated forces are redefining the fundamental relationship between hospitals and physicians. As part of a larger theory of organizational response to the environment, the effects of these external forces on hospital-medical staff organization were examined using both cross-sectional data and data collected at two points in time. Findings suggest that regulation and competition, at least up to 1982, have had relatively little direct effect on hospital medical staff organization. Rather, changes in medical staff organization are more strongly associated with hospital case mix and with structural characteristics involving membership in a multiunit system, size, ownership, and location. The pervasive effect of case mix and the consistent effect of multiunit system involvement support the need for policymakers to give these factors particular attention in considering how hospitals and their medical staffs might respond to future regulatory and/or competitive approaches.
新的支付形式、日益激烈的竞争、多机构医院系统的持续演变以及相关因素正在重新定义医院与医生之间的基本关系。作为组织对环境反应的更广泛理论的一部分，我们使用横断面数据和在两个时间点收集的数据，研究了这些外部力量对医院医务人员组织的影响。研究结果表明，至少在1982年之前，监管和竞争对医院医务人员组织的直接影响相对较小。相反，医务人员组织的变化与医院病例组合以及与多机构系统中的成员资格、规模、所有权和位置等结构特征的关联更为紧密。病例组合的普遍影响以及多机构系统参与的一致影响表明，政策制定者在考虑医院及其医务人员如何应对未来的监管和/或竞争方式时，有必要特别关注这些因素。
