Gary Young
Northeastern University, USA
Title: Effects of hospital - Physicians integration on quality of care: A study of cardiac services
Biography
Biography: Gary Young
Abstract
This study investigated whether integration of hospitals and physicians is associated with better care for patients with cardiac conditions. A dramatic change in the U.S. hospital industry is the integration of hospital and physicians through hospital acquisition of physician practices. Yet, little evidence exists regarding whether this form of integration leads to better quality of care. The study was conducted as an observational investigation and was based on a new theoretical model that integrated concepts from economics, organizational behaviour, and medical sociology. The study sample comprised over 300 hospitals in the State of California. The time frame for the study was 2010 to 2013. The key performance measures were hospitals’ degree of compliance with performance criteria set out by the federal government for managing patients with cardiac conditions. These criteria relate to the types of clinical tests and medications that cardiac patients should receive but hospital compliance requires the cooperation of physicians. Data for these measures were obtained from a federal web site that presents performance scores for U.S. hospitals. The key independent variable was the percentage of cardiologists that a hospital employs (versus cardiologists who are affiliated but not employed by the hospital). Data for this measure was obtained from the State of California which requires hospitals to report financial and operation data each year including numbers of employed physicians. Other characteristics of hospitals (e.g., information technology for cardiac care, volume of cardiac patients) were also evaluated as possible complements or substitutes for physician employment by hospitals. Additional sources of data included the American Hospital Association and the U.S. Census. Empirical models were estimated with generalized estimating equations (GEE). Findings suggest that physician employment is positively associated with better hospital performance for cardiac care. However, findings also suggest that information technology is a substitute for physician employment.
References:
Alexander, J.A. & Young, G.J. 2016. Health Professionals and Organizations – Moving toward True Symbiosis. In Hoff, T.J., Sutcliffe, K.M, & Young, G.J. (Eds.), The HealthCare Professional Workforce: Understanding Human Capital in a Changing Industry. New York, New York: Oxford University Press.
Baker, L.C., Bundorf, M. K., & Kessler, D.P., 2014. Vertical integration: Hospital ownership of physician practices is associated with higher prices and spending. Health Affairs, 33(5): 756-763.
Forbes, S.J. & Lederman, M., 2009. Adaptation and vertical integration in the airline industry. The American Economic Review, 99(5): 1831-1849.
Friedberg, M.W., Chen, P.G., White, C., Jung, O., Raaen, L., Hirschman, S., Hach, E., Stevens, C., Ginsburg, P.B., Casalino, L.P., Tutty, M., Vargo, C., Lipinski, L. 2015. Effects of Health Care Payment Models on Physician Practice in the United States. Santa Monica, CA: RAND Corporation.
Young, G. J., Nyaga, G. N., & Zepeda, D., 2016. Hospital employment of physicians and supply chain performance: An empirical investigation. Health Care Management Review, 41(3): 244-255.