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Snapshots of Change in Fifteen Communities:
Health System Integration: A Means to an End
Summer 1996
Health Affairs, vol.15, no.2 (Summer 1996): 92-106
Robert Miller
he creation of integrated firms and contractual networks in health
care often is a precondition for other forms of integration that could actually lower
costs and improve quality of care. Although different types of integration activities are
leading to innovations in the production of services and the care of populations, the
continued influence of the "old" indemnity insurance/fee-for-service system
creates important obstacles to those integration activities. If creation of integrated
firms and contractual networks races ahead of other forms of integration, it could produce
noncompetitive markets that reduce pressures to integrate in ways that can cut costs and
improve quality of care. Purchasers actions could play a major role in determining the
future of various integration activities.
Free access to this article is available at the Health
Affairs Web site.
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