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Snapshots of Change in Fifteen Communities: Health Affairs |
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The Dynamics of Market Level Change
April 1997
Journal of Health Politics, Policy and Law, vol.22, no.2 (April 1997): 363-382
Paul B. Ginsburg
ealth care exhibits a competitive dynamic today that increasingly
resembles that in other service industries. Organizations are becoming larger to achieve
scale economies and to increase market power. Vertical integration, whether through
ownership or complex contracts, is also being pursued both to seek efficiencies and to
improve the bargaining position of the organization. External forces that are driving
these changes include more aggressive activities on the part of purchasers to contain
their costs, developments in information technology, management innovation in other
service industries, and advances in medical technology. Within the heath care industry,
there is a pattern of organizations taking the initiative to respond to these external
forcess—often in anticipation of them—and other organizations then responding to
the pressures in turn placed on them. Although information on strategies is communicated
rapidly throughout the country, what is attempted and what succeeds differs a great deal
across communities. The nature of current health care institutions in the community,
including the presence of large entities with extensive capital and strong management in a
particular segment of the health system and the community’s experience with managed
care are important factors in the path that change takes.
For a full copy please visit Journal of Health Policy, Politics and Law. (Subscription required.)
