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Review
. 2008 Sep;86(3):375-434.
doi: 10.1111/j.1468-0009.2008.00527.x.

Hospital-physician collaboration: landscape of economic integration and impact on clinical integration

Lawton Robert Burns  1 , Ralph W Muller
Affiliations
Review

Hospital-physician collaboration: landscape of economic integration and impact on clinical integration

Lawton Robert Burns et al. Milbank Q. 2008 Sep.

Abstract

Context: Hospital-physician relationships (HPRs) are an important area of academic research, given their impact on hospitals' financial success. HPRs also are at the center of several federal policy proposals such as gain sharing, bundled payments, and pay-for-performance (P4P).

Methods: This article analyzes the HPRs that focus on the economic integration of hospitals and physicians and the goals that HPRs are designed to achieve. It then reviews the literature on the impact of HPRs on cost, quality, and clinical integration.

Findings: The goals of the two parties in HPRs overlap only partly, and their primary aim is not reducing cost or improving quality. The evidence base for the impact of many models of economic integration is either weak or nonexistent, with only a few models of economic integration having robust effects. The relationship between economic and clinical integration also is weak and inconsistent. There are several possible reasons for this weak linkage and many barriers to further integration between hospitals and physicians.

Conclusions: Successful HPRs may require better financial conditions for physicians, internal changes to clinical operations, application of behavioral skills to the management of HPRs, changes in how providers are paid, and systemic changes encompassing several types of integration simultaneously.

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Figures

Figure 1
Figure 1
Centralization of Hospital System, 2000–2006
See this image and copyright information in PMC

References

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