Health Services Research , vol.35, no.1, Part 1 (April 2000): 37-52
Linda T. Kohn
great deal of experimentation and apparent duplication exist in efforts to develop programs to influence physician practice patterns. Based on interviews with providers and other health care leaders in 12 communities as part of the Community Tracking Study, the authors found that responsibility for managing care is being contested by health plans, medical groups and hospitals, as each seeks to accrue the savings that can result from more efficient delivery of care. To manage the financial and clinical risk, providers are aggressively consolidating and reorganizing. Most significant is the rapid formation of intermediate organizations for contracting with managed care organizations. Despite the profound effect that managed care has on how providers are organized, it seems to have only a modest effect on how health care organizations deliver medical care. Rather than improving the efficiency of health care organizations, provider efforts to build large systems and become indispensable to health plans are exacerbating problems of excess capacity.
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