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The Fragmentation of U.S. Health CareCauses and Solutions$
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Einer Elhauge

Print publication date: 2010

Print ISBN-13: 9780195390131

Published to Oxford Scholarship Online: May 2010

DOI: 10.1093/acprof:oso/9780195390131.001.0001

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Of Doctors and Hospitals

Of Doctors and Hospitals

Setting the Analytical Framework for Managing and Regulating the Relationship

(p.135) 7 Of Doctors and Hospitals
The Fragmentation of U.S. Health Care

James F. Blumstein

Oxford University Press

This chapter considers the integration of (i) physician services and (ii) the institutional and economic interests of hospitals. These issues provide a vehicle for addressing the institutional fragmentation arising from existing hospital-governance regulation. How, and to what extent, should economic considerations factor into medical-care decision-making? What regulatory structure should govern physician–hospital interrelationships? Whereas hospitals once followed an “eBay” model, they now have their own institutional interests. Hospitals have independent duties to patients, and responsibilities to assure quality of care and manage costs. These realities call into question the traditional regulatory/governance structure of hospitals. The regulatory regime for integrated delivery networks (IDNs) is more flexible than the traditional JCAHO hospital model. The chapter concludes that (i) the legal/regulatory environment should not dictate how physician–hospital relationships should develop, nor the appropriate organizational form; and (ii) regulatory flexibility and “regulatory neutrality” should guide public policy in this arena.

Keywords:   hospital governance, physician–hospital relationships, integrated delivery networks, doctor–hospital joint ventures

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