Clinical Integration: An Economic and Clinical Integration: An - - PowerPoint PPT Presentation

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 Clinical Integration in Health Care: A Check-

• Up

Up 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

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What is What is “ “clinical integration? clinical integration?” ”

• Physician

Physician-

• physician

physician

• Physician

Physician-

• hospital

hospital

• Hospital

Hospital-

• hospital

hospital

• Clarity on details

Clarity on details

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Who Who’ ’s involved? s involved?

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What are the objectives? What are the objectives?

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Do different groups share the same perspectives? Do different groups share the same perspectives?

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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?

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Efficiency Example: Efficiency Example: “ “Identifying, Categorizing, and Evaluating Identifying, Categorizing, and Evaluating 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

Coase ( (“ “The Nature of the Firm, The Nature of the Firm,” ” 1937) 1937) and many others and many others

– – Existence

Existence: Why do firms emerge? : Why do firms emerge?

– – Boundaries

Boundaries: Where are firms located? : Where are firms located? Which transactions are performed Which transactions are performed internally? Which are negotiated by the internally? Which are negotiated by the market? market?

– – Organization

Organization: Why are firms structured in : Why are firms structured in 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

• r “

“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

• Many unanswered questions, but potentially

Many unanswered questions, but potentially answerable answerable

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Conceptual Conceptual

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Empirical Empirical

• Next steps?

Next steps?

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Research agenda Research agenda

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Who to lead Who to lead

• AHRQ has history of research in area

AHRQ has history of research in area

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Extramural Extramural

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Intramural Intramural

Research Perspective Research Perspective

Herbert.Wong@ahrq.hhs.gov Herbert.Wong@ahrq.hhs.gov