TY - JOUR
T1 - Understanding competition between healthcare providers
T2 - Introducing an intermediary inter-organizational perspective
AU - Westra, Daan
AU - Angeli, Federica
AU - Carree, Martin
AU - Ruwaard, Dirk
PY - 2017/2/1
Y1 - 2017/2/1
N2 - 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.
AB - 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.
KW - Health outcomes
KW - Inter-organizational cooperation
KW - Inter-organizational networks
KW - Managed competition
KW - Market structure
KW - Pro-competitive reform
UR - http://www.scopus.com/inward/record.url?scp=85008191249&partnerID=8YFLogxK
U2 - 10.1016/j.healthpol.2016.11.018
DO - 10.1016/j.healthpol.2016.11.018
M3 - Article
C2 - 27986338
AN - SCOPUS:85008191249
SN - 0168-8510
VL - 121
SP - 149
EP - 157
JO - Health Policy
JF - Health Policy
IS - 2
ER -