HORIZONTAL AND VERTICAL INTEGRATION OF PHYSICIANS: A TALE OF TWO TAILS
HORIZONTAL AND VERTICAL INTEGRATION OF PHYSICIANS: A TALE OF TWO TAILS
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DOI：
10.1108/s1474-8231(2013)0000015009
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发表时间：
2013-01-01
期刊：
影响因子：
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通讯作者：
Sen, Aditi
中科院分区：
文献类型：
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作者：
Burns, Lawton Robert;Goldsmith, Jeff C.;Sen, Aditi
目的-研究人员建议将医学专业重组为具有多专业组合的更大群体。我们分析是否有证据表明这些模型的优越性，如果这种组织转型正在进行中，设计/方法-方法我们总结的证据在医生组的实践规模和范围经济，然后审查医生组的规模和专业组合的趋势进行生存率测试的最有效的models.Findings -医生组的分布表现出两个有趣的尾巴。在下尾，很大比例的医生继续在医生拥有的小型诊所执业。在上尾，有一个小的，但迅速增长的百分比，大集团已组织主要由非医生业主。研究限制-虽然我们的分析包括没有原始数据，它整理了所有已知的调查医生的做法特点和小组的做法形成，以提供一个一致的图片医生组织。我们的回顾表明，在医生执业的规模和范围经济是有限的。这可能解释了为什么大多数医生保留了他们的小诊所。实际意义-更大的，多专业的团体主要由非医生业主在垂直整合安排。几乎没有证据支持这种模式的效率和一些关注，他们可能会构成反竞争的威胁。独创性/价值-这是第一次全面审查的规模和范围经济的医生执业近二十年。研究结果似乎没有太大的变化，也没有太大的变化，在医生的执业组织。
Purpose - Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway.Design/methodology - approach We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models.Findings - The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.Research limitations - While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization.Research implications - Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices. Practical implications Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats.Originality/value - This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.