Clinical Integration: An Economic and Clinical Integration: An Economic and Research Perspective Research Perspective Herbert Wong, Ph.D. Herbert Wong, Ph.D. Center for Delivery, Organization and Markets Center for Delivery, Organization and Markets Clinical Integration in Health Care: A Check- -Up Up Clinical Integration in Health Care: A Check FTC Workshop FTC Workshop May 29, 2008 May 29, 2008
Outline Outline � Similarities with � Similarities with “ “efficiency efficiency” ” discussion discussion � Potential theory � Potential theory � Relevant literature � Relevant literature � Research perspective � Research perspective
Similarities with Efficiency Similarities with Efficiency � � Parallels healthcare efficiency discussion Parallels healthcare efficiency discussion What is “ “clinical integration? clinical integration?” ” – What is – � � Physician- Physician -physician physician � � Physician- -hospital hospital Physician � � Hospital- -hospital hospital Hospital � � Clarity on details Clarity on details Who’ ’s involved? s involved? – Who – What are the objectives? – What are the objectives? – Do different groups share the same perspectives? – Do different groups share the same perspectives? – Is there evidence that these objectives are achieved? – Is there evidence that these objectives are achieved? – � � Is a typology / synthesis needed? Is a typology / synthesis needed? Efficiency Example: “ “Identifying, Categorizing, and Evaluating Identifying, Categorizing, and Evaluating – – Efficiency Example: Health Care Efficiency Measures,” Health Care Efficiency Measures, ” recent AHRQ report recent AHRQ report
Potential Theory Potential Theory � Economics: Theory of the Firm � Economics: Theory of the Firm Coase ( (“ “The Nature of the Firm, The Nature of the Firm,” ” 1937) 1937) – Coase – and many others and many others Existence: Why do firms emerge? : Why do firms emerge? – Existence – Boundaries: Where are firms located? : Where are firms located? – Boundaries – Which transactions are performed Which transactions are performed internally? Which are negotiated by the internally? Which are negotiated by the market? market? Organization: Why are firms structured in : Why are firms structured in – Organization – specific way? What is interplay of formal specific way? What is interplay of formal and informal relationships? and informal relationships?
Key Concepts Key Concepts � Product / service � Product / service � Input � Input � “ � “Make Make” ” or or “ “buy buy” ” Transaction costs – Transaction costs – � Competition � Competition � Complex interactions � Complex interactions
Relevant Literature Relevant Literature � Does clinical integration improve � Does clinical integration improve efficiency, lower costs, improve quality? efficiency, lower costs, improve quality? � Few, if any, direct empirical studies � Few, if any, direct empirical studies � Related work � Related work Healthcare markets and market forces – Healthcare markets and market forces – Cost and quality of care – Cost and quality of care – – Mergers, closures, product lines, competition Mergers, closures, product lines, competition – Organizational characteristics – Organizational characteristics –
Research Perspective Research Perspective � � Many unanswered questions, but potentially Many unanswered questions, but potentially answerable answerable – Conceptual – Conceptual Empirical – Empirical – � � Next steps? Next steps? – Research agenda – Research agenda Who to lead – Who to lead – � � AHRQ has history of research in area AHRQ has history of research in area Extramural – Extramural – Intramural – Intramural –
Herbert.Wong@ahrq.hhs.gov Herbert.Wong@ahrq.hhs.gov
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