Institutional change and healthcare organizations: from professional dominance to managed care
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Chicago, Ill. [u.a.]
Univ. of Chicago Press
2000
|
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XXV, 427 S. graph. Darst. |
| ISBN: | 0226743098 0226743101 |
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| 245 | 1 | 0 | |a Institutional change and healthcare organizations |b from professional dominance to managed care |c W. Richard Scott ... |
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| 300 | |a XXV, 427 S. |b graph. Darst. | ||
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| 650 | 4 | |a History, 20th Century |z San Francisco | |
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Datensatz im Suchindex
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| adam_text | Contents
List of Figures and Tables xi
List of Case Lllustrations xv
Preface xvii
Acknowledgments xxi
1. A World in Transition 1
Overview of Study 2
Theoretical Framework 5
Precursor Studies 5
Limitations That Point the Way 8
Integrating Levels and Perspectives 9
Environments 17
Limitations of Our Research 22
The Larger Issues 24
Profound Institutional Change 24
Congruence 26
Structuration 26
2. The Case of the San Francisco Bay Area:
Focal Populations and Organizations 28
San Francisco Bay Area 28
Organizational Actors in the Healthcare Field 32
Types of Social Actors 32
Functions of Social Actors 33
Institutional Roles of Social Actors 35
Focal Populations of Organizations 36
Selecting the Populations 36 v
Contents
Data Collected on Focal Populations 38
Hospitals 39
Health Maintenance Organizations 40
Home Health Agencies 44
End Stage Renal Disease Centers 46
Multihospital and Integrated Healthcare Systems 47
Other Organizational Populations 49
Medical Groups 49
Preferred Provider Organizations 50
Focal Organizational Case Studies 51
Kaiser Permanente Medical Care Program 51
Palo Alto Medical Clinic 53
Stanford University Hospital 53
San Jose Hospital 54
Data Sources 55
Conclusion: Diverse Data, Multiple Levels 55
3. Changing Healthcare Delivery Systems 57
Major Trends in U.S. Healthcare Delivery Systems 57
Increased Concentration 58
Increased Specialization 58
Increased Integration and Diversification 59
Increased Linkages among Healthcare Organizations 610
Increased Privatization 60
Increased Market Orientation 61
Theories of Organizational Change 62
A General Typology 62
Internal versus External Sources of Change 63
Intentional versus Unintentional Change 65
Incremental versus Discontinuous Change 67
Changes in Populations of Healthcare Organizations 69
Trends in Focal Organizational Populations 70
Trends in Two Other Populations 86
Comparing Population Trends 88
Blurred and Shifting Boundaries 91
Conclusion 95
4. Processes Shaping Organizational Populations:
Ecological and Adaptive Change 96
Changes in Hospital Characteristics 97
Contents vii
Hospital Size 97
Hospital Attributes 103
Changes in Organizational Ownership 109
Trend toward Proprietary Forms 110
Trend toward Privatization 118
Changes in Organizational Subtypes 119
Generalist versus Specialist Hospitals 119
Forms of Physician Organization among HMOs 120
Conclusion 121
5. Resource Environments and Organizational
Dynamics 124
Perspectives on Material Resource Environments 124
Health Economics 125
Industrial Organization Economics 128
Trends in Material Resource Environments in the Bay Area
and Beyond 130
Changes of Characteristics Affecting Demand 130
Changes in Characteristics Affecting Supply 139
Changes in Technology 144
Rise in Healthcare Expenditures 146
Resource Environments and Healthcare Organizations 148
Resource Partitioning 148
Institutional Effects on Resource Environments 149
Entries into Organizational Populations 150
Exits from Organizational Populations 156
Effects of Institutional Eras on Resource Environments 161
Conclusion 164
6. The Changing Institutional Environment 166
Conceptualizing and Studying Institutional Environments 767
Three Institutional Elements 167
Three Institutional Components 170
Charting Change in Healthcare Institutional Components 175
Institutional Eras in American Healthcare 175
The Era of Professional Dominance (1945 65) 178
The Era of Federal Involvement (1966 82) 195
The Era of Managerial Control and Market Mechanisms (1983 present) 217
Conclusion 234
viii Contents
7. Institutional Environments and Organizational
Legitimacy 236
Governance Structures and Healthcare Organizations 236
Legitimacy and Organizational Survival 237
Normative Legitimacy 238
Cognitive Legitimacy 248
Regulative Legitimacy 250
Legitimacy, Performance, and Organizational Survival 258
Conclusion 263
8. Horizontal, Vertical, and Virtual Integration of
Healthcare Organizations 265
Multihospital Systems 267
The Development of Hospital Associations and Multihospital Systems 267
Trends in Bay Area Systems 271
Governance Structures in Systems 276
Determinants of System Membership 280
Integrated Healthcare Systems 287
Loci of Integration 287
Modes of Integration and Interdependence 288
Types of Integration 290
Combining Forms of Interdependence and Modes of Integration 296
Evidence of Rising Integration in the Bay Area 296
Analysis of Make or Buy Decisions 301
Conclusion: The Changing Structure of Linkages among Healthcare
Organizations 308
9. Institutional Environments and the
Organizational Field 312
Depicting Profound Institutional Change 312
Institutional Logics 312
Institutional Fragmentation 317
Dynamics of Institutional Change 324
Decline of Professional Dominance 326
Advance of Managerial Market Orientation 328
Field level Forces and Organizational Populations 329
Field level Forces and Fitness of Forms 330
Empirical Evidence 333
Summary and Conclusion 337
Contents ix
10. Institutional Change and Structuration
Processes 340
Modes of Governance and the Welfare State 340
Identifying Profound Change in Social Systems: Reviewing Criteria and
Evidence 345
Multilevel Change 345
Discontinuous Change 346
New Rules and Governance Mechanisms 348
New Logics 349
New Types of Actors 351
New Meanings 353
New Relations among Actors 354
Changes in Organizational Boundaries 355
Change in Field Boundaries 356
The Structuration and Destructuration of Organizational Fields 358
A Concluding Comment 363
Appendix A: Data Sources for Organizational
Populations 365
Appendix B: Supplemental Data and Analyses 367
Statistical Comparison of Ecological and Adaptive Change 367
Evidence of Discontinuous Change 368
Appendix C: Quantitative Methodology 373
Organizational Entries 373
Organizational Exits 374
Organizational Adaptation 375
Factor Analysis 376
Glossary of Abbreviations and Acronyms 379
References 383
Index 419
Figures and Tables
Figures
2.1. San Francisco Bay Area 29
2.2. The Healthcare Field: Principal Social Actors and Functions 34
3.1. Bay Area Hospital Entries, 1945 92 71
3.2. Bay Area Hospital Exits, 1945 91 72
3.3. Bay Area Hospitals, 1945 92 73
3.4. Bay Area Hospital Capacity Utilization, 1945 91 73
3.5. Proportion of Bay Area Hospitals by Ownership Type, 1954 92 75
3.6. Bay Area HMO Entries and Exits, 1945 92 76
3.7. Bay Area HMOs, 1945 92 76
3.8. Bay Area HMO Market Penetration, 1945 90 77
3.9. Proportion of Bay Area HMO Subtypes, 1976 92 79
3.10. Bay Area HHA Entries and Exits, 1966 92 81
3.11. Total and Hospital Based Bay Area HHAs, 1966 92 82
3.12. Bay Area ESRDC Entries and Exits, 1969 91 83
3.13. Total and Hospital Based Bay Area ESRDCs, 1969 91 84
3.14. Bay Area Medical Groups and PPOs, 1945 93 88
3.15. Bay Area Organizational Populations, 1945 92 89
4.1 a. Net Change in Total Bed Capacity of Bay Area Hospitals, 1946 91 99
4.1 b. Adaptive and Ecological Components of Change in Total Bed Capacity of Bay Area
Hospitals, 1946 91 100
4.2. Distributional Change in Bed Capacity of Bay Area Hospitals, 1950 90 104—5
5.1. Demographic Composition of the Bay Area, 1940 90 132
5.2. Health Insurance Coverage of the U.S. Population, 1940 94 135
5.3. Bay Area Public Health Expenditures, 1942 92 136
5.4. Physician to Population Ratios in the United States, California, and the Bay Area,
1945 92 141
5.5a. Bay Area Hospital Market Concentration, 1945 92 143 xi
xii Figures and Tables
5.5b. Bay Area HHA Market Concentration, 1978 92 143
5.6. Medical and Drug Patents Issued in the United States, 1946 94 145
5.7. National Health Expenditures as a Proportion of GDP, 1940 94 146
5.8. Annual Point Change in Medical and Consumer Price Inflation in the United States,
1941 94 147
5.A. 1. San Francisco Bay Area Kaiser Foundation Hospitals: Locations and Founding
Dates 159
6.1. Membership in General Physician Associations, 1940 92 179
6.2. Health Insurance Benefit Expenditures in the United States by Type of Insurer,
1948 94 181
6.3. General and Specialist Practitioners in the United States, 1940 94 183
6.4. Private Philanthropy for Health and Hospitals in the United Staates, 1945 94 184
6.5. American Medical Board Specialties and California Licensed Health Occupations,
1945 95 187
6.6. Expenditures for Medical Research in the United States, 1940 94 190
6.7. Expenditures for Medical Facilities Construction in the United States,
1940 94 191
6.8a. U.S. Regulatory Policy in Healthcare Services, 1930 93 192
6.8b. California Regulatory Policy in Healthcare Services, 1930 93 193
6.9. Expenditures for Health and Medical Services in the United States, 1940 94 196
6.10. Health Related Regulatory Bodies in the United States, California, and the Bay
Area, 1950 92 198
6.11. Health Related Index Pages in U.S. and California Statutory Codes, 1946 94 199
6.A. 1. Bay Area Health Planning Bodies by Type, 1940 92 203
6A.2. HealthPlznningArticles, Modern Healthcare, 1966 95 204
6.12. Health Related Titles in the Guide to Periodical Literature, 1945 95 211
6.13. California Licensed Chiropractors and Acupuncturists, 1940 94 214
6.14. Recognized Health Administration Training Programs in the United States,
1949 95 216
6.15a. Managerial Market Oriented Articles, Modern Healthcare, 1966 95 221
6.15b. Managerial Market Oriented Articles, Journal of the American Medical Association,
1966 95 222
6.16. Health Services Companies and Market Value among the 1000 Largest American
Firms, 1945 94 231
7.1. Bay Area Hill Burton (Title VI and XVI) Projects, 1949 90 253
8.1. Bay Area Hospitals, Member Hospitals, and Systems, 1945 97 272
8.2. Bay Area Systems by Ownership Type, 1945 97 275
8.3. Proportion of Bay Area Systems by Ownership Type, 1945 97 276
8.4. Proportion of Bay Area Hospitals with HHA Contracts and Ownership Relations,
1976 91 298
Figures and Tables xiii
8.5. Proportion of Bay Area Hospitals with ESRDC Contracts and Ownership Relations,
1976 91 299
8.6. Proportion of Bay Area Hospitals with Purchaser and Provider Contracts,
1980 90 305
8.7. Comparison of Linkages among Organizational Populations in the Bay Area, 1980
and 1990 309
9.1. Primary Logics in U.S. Healthcare, Factor Score Trends, 1948 93 314
9.2. Fragmentation ofGovernance in Bay Area Hospital Accreditations, 1954—92 319
9.3. Fragmentation ofGovernance Structures in U.S., California, and Bay Area, Factor
Score Trends, 1950 91 322
9.4. Field Fragmentation in U.S. Healthcare, Factor Score Trends, 1950 93 323
Ta bles
2.1. Types of Managed Care Organizations 43
2.2. Organizations: Four Case Studies 52
3.1. Types and Levels of Change 69
3.2. Organizational Populations in San Mateo and Santa Clara Counties 91
3.3. Blending of Medical Groups with Other Delivery Forms in the Bay Area, 1993 92
4.1. Proportion of Change in Bay Area Hospital Attributes Accounted for by Adaptation,
1946 91 107
4.2. Adaptive Change in Ownership: Transition Rates of Bay Area Hospitals, HHAs,
and ESRDCs 111
4.3 Adaptive and Ecological Components of Change in Ownership: Bay Area Hospitals,
HHAs, and ESRDCs 112
4.4 Adaptive Change in Organizational Subtypes: Initial and Adopted Methods of
HMO Form Conversions, 1976 92 121
5.1. Demographic, Geographic, and Funding Bases of Resource Partitioning for Hospi¬
tals, HHAs, and ESRDCs 153
5.2. Models of Entry into Bay Area Hospital, HHA, and ESRDC Populations 155
5.3. Models of Exit from Bay Area Hospital and HHA Populations 158
5.4. Models of Entry into Bay Area Hospitals and HHAs, with Period Effects 162
5.5. Models of Exit from Bay Area Hospitals and HHAs, with Period Effects 164
6.A.I. Health Planning Governance Regimes, 1932 82 200
6.A.2. Modifications in Meaning of Health Planning, Modern Healthcare, 1966 85 205
6.1. Actors, Logics, and Governance Structures in the Healthcare Sector across Three
Institutional Eras 234
7.1. Proportion of Bay Area Hospitals with Accreditations by Type, 1945—90 240
7.2. Rotated Factor Solution for Managerial and Technical Legitimacy 244
7.3. Effects of Normative and Cognitive Legitimacy on Exits from Bay Area Hospital
Population, 1945 90 246
xiv Figures and Tables
7.4. Effects of Regulatory Legitimacy and Funding on Exits from Bay Area Hospital
Population, 1945 90 258
7.5. Effects of Organizational Performance on Exits from Bay Area Hospital Population,
1945 90 262
8.1. Selected Differences among Bay Area Multihospital System Types, 1945 91 286
8.2. Cox Models of Bay Area Hospital Entry into Multihospital Systems, 1946 91 287
8.3. Typology of Interdependence and Coordinating Mechanisms 297
8.4. Logit Models of Make or Buy Decisions for Bay Area Hospital Services,
1976 91 303
8.5. Cox Models of Bay Area Hospital Purchaser Provider Contracting, 1981 87 307
9.1. Confirmatory Factor Models ofPrimary Logics in U.S. Healthcare, 1948 94 314
9.2. Confirmatory Factor Models of Field Fragmentation in U.S. Healthcare,
1945 94 321
9.3. Decline of Professional Dominance: Indicators Affecting Factor Score Measure of
Professional Dominance in U.S. Healthcare, 1951 93 327
9.4. Advance of Managerial Market Orientation: Indicators Affecting Factor Score Mea¬
sure of Managerial Market Logics in U.S. Healthcare, 1951 93 330
9.5. Predicted Fitness of Organizational Forms in Material Resource and Institutional
Environments 334
9.6. Impact of Field Level Forces on Entries into Bay Area Hospital, HHA, and ESRDC
Populations 335
9.7. Impact of Field Level Forces on Exits from Bay Area Hospital and HHA
Populations 337
10.1. Field Dimensions and Indicators 361
10.2. Field Dimensions and Institutional Eras 362
A. 1. Summary of Principal Data Sources 365
A.2. Summary of Measures Collected for the Focal Populations 366
B. 1. One Way ANOVA with Scheffe Multiple Comparison Test of Structural Inertia
(N = 286) 368
B.2. Fixed Effect Models of Regulatory Impact on Bay Area Hospital Privatization,
1945 92 370
B.3. Fixed Effect Models of Regulatory Impact on Bay Area HHA and ESRDC Priva¬
tization 370
Case Illustrations
3.A. Kaiser Permanente s Representation in Focal Populations 85
3.B. Blurred Boundaries of the Palo Alto Medical Clinic 93
4.A. Facility Expansion and Contraction: San Jose Hospital 101
4.B. Causes and Consequences of Ownership Change: San Jose Hospital and Stanford
Medical Center 114
5.A. Entry and Exit of Kaiser Permanente Hospitals 159
6.A. Health Planning: Refractions of Changing Logics 199
6.B. Responses to Governmental Initiatives in the Era of Federal Involvement 207
7 A. Hill Burton Financing and Legitimacy: Program Effects on San Jose, Stanford, and
Kaiser Permanente Hospitals 254
7.B. Quality and Performance at Kaiser Permanente 259
8 A. Multihospital Systems in the Era of Professional Dominance 273
8.B. Diversity of Governance Structures in Bay Area Healthcare Systems 278
8.C. San Jose Hospital Joins a System 281
xv
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| id | DE-604.BV014219242 |
| illustrated | Illustrated |
| indexdate | 2024-07-09T18:59:50Z |
| institution | BVB |
| isbn | 0226743098 0226743101 |
| language | English |
| oai_aleph_id | oai:aleph.bib-bvb.de:BVB01-009749359 |
| oclc_num | 42689995 |
| open_access_boolean | |
| owner | DE-19 DE-BY-UBM DE-83 DE-188 |
| owner_facet | DE-19 DE-BY-UBM DE-83 DE-188 |
| physical | XXV, 427 S. graph. Darst. |
| publishDate | 2000 |
| publishDateSearch | 2000 |
| publishDateSort | 2000 |
| publisher | Univ. of Chicago Press |
| record_format | marc |
| spelling | Institutional change and healthcare organizations from professional dominance to managed care W. Richard Scott ... Chicago, Ill. [u.a.] Univ. of Chicago Press 2000 XXV, 427 S. graph. Darst. txt rdacontent n rdamedia nc rdacarrier Geschichte 1900-2000 Gezondheidszorg gtt Médecine - Californie - San Francisco, Région de la baie de - Histoire - 20e siècle Organisatieverandering gtt Santé, Services de - Administration - Californie - San Francisco, Région de la baie de - Histoire - 20e siècle Soins médicaux - Californie - San Francisco, Région de la baie de - Histoire - 20e siècle Geschichte Gesundheitswesen Medizin Delivery of Health Care history San Francisco Health Services Administration history San Francisco Health services administration California San Francisco Bay Area History 20th century History, 20th Century San Francisco Medical care California San Francisco Bay Area History 20th century Medicine California San Francisco Bay Area History 20th century Pflegeeinrichtung (DE-588)4400739-5 gnd rswk-swf Organisationswandel (DE-588)4075693-2 gnd rswk-swf Pflegeeinrichtung (DE-588)4400739-5 s Organisationswandel (DE-588)4075693-2 s DE-604 Scott, W. Richard 1932- Sonstige (DE-588)124685900 oth HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=009749359&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Institutional change and healthcare organizations from professional dominance to managed care Gezondheidszorg gtt Médecine - Californie - San Francisco, Région de la baie de - Histoire - 20e siècle Organisatieverandering gtt Santé, Services de - Administration - Californie - San Francisco, Région de la baie de - Histoire - 20e siècle Soins médicaux - Californie - San Francisco, Région de la baie de - Histoire - 20e siècle Geschichte Gesundheitswesen Medizin Delivery of Health Care history San Francisco Health Services Administration history San Francisco Health services administration California San Francisco Bay Area History 20th century History, 20th Century San Francisco Medical care California San Francisco Bay Area History 20th century Medicine California San Francisco Bay Area History 20th century Pflegeeinrichtung (DE-588)4400739-5 gnd Organisationswandel (DE-588)4075693-2 gnd |
| subject_GND | (DE-588)4400739-5 (DE-588)4075693-2 |
| title | Institutional change and healthcare organizations from professional dominance to managed care |
| title_auth | Institutional change and healthcare organizations from professional dominance to managed care |
| title_exact_search | Institutional change and healthcare organizations from professional dominance to managed care |
| title_full | Institutional change and healthcare organizations from professional dominance to managed care W. Richard Scott ... |
| title_fullStr | Institutional change and healthcare organizations from professional dominance to managed care W. Richard Scott ... |
| title_full_unstemmed | Institutional change and healthcare organizations from professional dominance to managed care W. Richard Scott ... |
| title_short | Institutional change and healthcare organizations |
| title_sort | institutional change and healthcare organizations from professional dominance to managed care |
| title_sub | from professional dominance to managed care |
| topic | Gezondheidszorg gtt Médecine - Californie - San Francisco, Région de la baie de - Histoire - 20e siècle Organisatieverandering gtt Santé, Services de - Administration - Californie - San Francisco, Région de la baie de - Histoire - 20e siècle Soins médicaux - Californie - San Francisco, Région de la baie de - Histoire - 20e siècle Geschichte Gesundheitswesen Medizin Delivery of Health Care history San Francisco Health Services Administration history San Francisco Health services administration California San Francisco Bay Area History 20th century History, 20th Century San Francisco Medical care California San Francisco Bay Area History 20th century Medicine California San Francisco Bay Area History 20th century Pflegeeinrichtung (DE-588)4400739-5 gnd Organisationswandel (DE-588)4075693-2 gnd |
| topic_facet | Gezondheidszorg Médecine - Californie - San Francisco, Région de la baie de - Histoire - 20e siècle Organisatieverandering Santé, Services de - Administration - Californie - San Francisco, Région de la baie de - Histoire - 20e siècle Soins médicaux - Californie - San Francisco, Région de la baie de - Histoire - 20e siècle Geschichte Gesundheitswesen Medizin Delivery of Health Care history San Francisco Health Services Administration history San Francisco Health services administration California San Francisco Bay Area History 20th century History, 20th Century San Francisco Medical care California San Francisco Bay Area History 20th century Medicine California San Francisco Bay Area History 20th century Pflegeeinrichtung Organisationswandel |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=009749359&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| work_keys_str_mv | AT scottwrichard institutionalchangeandhealthcareorganizationsfromprofessionaldominancetomanagedcare |