Institutional Change and Healthcare Organizations: From Professional Dominance to Managed Care
Few 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.
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accreditation activities administrative American Hospital Association analysis associated Bay Area Hospital bed capacity boundaries California Casalino centers chap chapter clinical Columbia/HCA competition contracting corporate costs decline density ecological effects employed entries eras ESRD ESRDCs examine existing exits expenditures facilities federal involvement for-profit fragmentation functions funding governance structures Hannan health maintenance organizations health planning healthcare field healthcare organizations healthcare sector healthcare services healthcare systems HHAs Hill-Burton HMOs home health agencies hospital survival important increased increasingly indicators institutional environments institutional logics integration JCAHO Kaiser Permanente legitimacy linkages managed managed care managerial managerial-market Medicaid medical groups Medicare multihospital systems nonprofit normative operating organizational field organizational forms organizational populations ownership patients percent physicians PPOs preferred provider organizations processes professional dominance programs proportion providers rates regulatory role significant social actors trend types units variables