Institutional Change and Healthcare Organizations: From Professional Dominance to Managed CareFew large institutions have changed as fully and dramatically as the U.S. healthcare system since World War II. Compared to the 1930s, healthcare now incorporates a variety of new technologies, service-delivery arrangements, financing mechanisms, and underlying sets of organizing principles. This book examines the transformations that have occurred in medical care systems in the San Francisco Bay area since 1945. The authors describe these changes in detail and relate them to both the sociodemographic trends in the Bay Area and to shifts in regulatory systems and policy environments at local, state, and national levels. But this is more than a social history; the authors employ a variety of theoretical perspectives—including strategic management, population ecology, and institutional theory—to examine five types of healthcare organizations through quantitative data analysis and illustrative case studies. Providing a thorough account of changes for one of the nation's leading metropolitan areas in health service innovation, this book is a landmark in the theory of organizations and in the history of healthcare systems. |
Contents
A WORLD IN TRANSITION | 1 |
CHANGING HEALTHCare DeliverY SYSTEMS | 57 |
1a Net Change in Total Bed Capacity of Bay Area Hospitals 194691 | 99 |
RESOURCE ENVIRONMENTS AND ORGANIZATIONAL | 124 |
5a Bay Area Hospital Market Concentration 194592 143 xi | 143 |
THE CHANGING INSTITUTIONAL ENVIRONMENT | 166 |
INSTITUTIONAL ENVIRONMENTS AND ORGANIZATIONAL | 236 |
Legitimacy Performance and Organizational Survival | 258 |
The Changing Structure of Linkages among Healthcare | 308 |
Dynamics of Institutional Change | 324 |
Summary and Conclusion | 337 |
INSTITUTIONAL CHANGE AND STRUCTURATION | 340 |
The Structuration and Destructuration of Organizational Fields | 358 |
DATA SOURCES FOR ORGANIZATIONAL | 365 |
QUANTITATIVE METHODOLOGY | 373 |
Glossary of Abbreviations and Acronyms | 379 |
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accreditation adaptive Administration American analysis associated Bay Area Hospital California CalPERS Casalino centers chap Chiropractic clinical Columbia/HCA competition contracting costs delivery ecological effects entries ESRDCs examine existing exits expenditures facilities federal involvement for-profit funding governance structures Hannan health maintenance organizations Health Planning Health Services healthcare field healthcare organizations healthcare sector healthcare services healthcare systems HHAs Hill-Burton HMOs home health agencies important increased institutional environments institutional logics integration JCAHO Kaiser Permanente legitimacy linkages managed care Management managerial managerial-market Medicaid medical groups Medicare Multihospital Systems nonprofit normative Organizational Ecology organizational field organizational forms organizational populations ownership patients percent period physicians PPOs preferred provider organizations processes professional dominance programs proportion providers rates regulatory Review San Francisco San Jose San Jose Mercury Shortell social actors Stanford strategic trend types United variables