Robinson J C, Casalino L P
University of California, Berkeley, USA.
Health Aff (Millwood). 1996 Spring;15(1):7-22. doi: 10.1377/hlthaff.15.1.7.
This paper documents the growing linkages between primary care-centered medical groups and specialists and between physicians and hospitals under managed care. We evaluate the two alternative forms of organizational coordination: "vertical integration," based on unified ownership, and "virtual integration," based on contractual networks. Excess capacity and the need for investment capital are major short-term determinants of these vertical versus virtual integration decisions in health care. In the longer term, the principal determinants are economies of scale, risk-bearing ability, transaction costs, and the capacity for innovation in methods of managing care.
本文记录了以初级保健为中心的医疗集团与专科医生之间以及在管理式医疗下医生与医院之间日益紧密的联系。我们评估了两种组织协调的替代形式：基于统一所有权的“纵向整合”和基于契约网络的“虚拟整合”。产能过剩和投资资本需求是医疗保健领域这些纵向与虚拟整合决策的主要短期决定因素。从长期来看，主要决定因素是规模经济、风险承担能力、交易成本以及医疗管理方法的创新能力。
