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Understanding competition between healthcare providers: Introducing an intermediary inter-organizational perspective

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Publication details

JournalHealth Policy
DateAccepted/In press - 23 Nov 2016
DatePublished (current) - 1 Feb 2017
Issue number2
Number of pages9
Pages (from-to)149-157
Original languageEnglish


Pro-competitive policy reforms have been introduced in several countries, attempting to contain increasing healthcare costs. Yet, research proves ambiguous when it comes to the effect of competition in healthcare, with a number of studies highlighting unintended and unwanted effects. We argue that current empirical work overlooks the role of inter-organizational relations as well as the interplay between policy at macro level, inter-organizational networks at meso level, and outcomes at micro level. To bridge this gap and stimulate a more detailed understanding of the effect of competition in health care, this article introduces a cross-level conceptual framework which emphasizes the intermediary role of cooperative inter-organizational relations at meso level. We discuss how patient transfers, specialist affiliations, and interlocking directorates constitute three forms of inter-organizational relations in health care which can be used within this framework. The paper concludes by deriving several propositions from the framework which can guide future research.

    Research areas

  • Health outcomes, Inter-organizational cooperation, Inter-organizational networks, Managed competition, Market structure, Pro-competitive reform

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