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PubMedDate not supplied

Catholic healthcare's future. Ten models for competition and capitation.

In the next five years, Catholic providers must select strategies that will involve affiliations, acquisitions, and consolidations with Catholic and non-Catholic partners. At least 10 options are available to meet the long-term trends of managed care, competition, and capitation. Vertical integration allows comprehensive patient care. Multisponsor management can help religious institutes expand their market share. Systems and one-hospital sponsors can affiliate their facilities to form Catholic networks. Community-based not-for-profit networks can include both Catholic and non-Catholic organizations bound by contracts and joint ventures. Joint ventures provide the benefits of integration to Catholic providers, who must be willing to commit substantial capital to create HMOs and other networks with non-Catholic partners. Acquisition of facilities and regional and statewide expansion can strengthen a Catholic system's market position in the face of declining acute care hospital services. Catholic/non-Catholic mergers risk consolidating and closing facilities but need not erase Catholic identity. Cooperation between affiliation and merger, or "co-opetition," involves creating new legal territory for Catholic/non-Catholic consolidation. Divestiture may be an ultimate strategy, but Catholic sponsors must proceed with caution in their dealings with plentiful buyers. Catholic facilities and systems are joining with Catholic Charities, other providers, and local agencies to create networks.

Capitation Fee↗
PubMed2002

Interorganizational networks: using a theoretical model to predict effectiveness of rural health care delivery networks.

Interorganizational health care delivery networks have potential for sustaining health services delivery in rural areas faced with economic and demographic challenges. Four Nebraska rural health care delivery networks (Albion-Ord, Blue River Valley, Rural Partners, Inc., and Western Nebraska) were compared to an interorganizational model based on theories of interorganizational relations, exchange, population ecology, and synthesized collaboration. It assumes that outcomes, including effectiveness, are influenced by external and internal factors that are operationalized through external control, technology, structure, and operational process variables. Data were collected by a non-random, two-level cluster mail survey of network members (45/59 = 76.3% response rate). All networks received technical assistance from the Nebraska Office of Rural Health. Networks have formal organization, strategic plans, and official coordinators. Hospital administrators hold most leadership positions; few doctors or citizens are involved. Correlation and multiple regression analysis show partial fit between the research model and study networks. Effectiveness, measure by the gap between best possible and actual practice, increased with network connectivity (r=.36, p<.05), group methods of administrative decision-making (r=.52, p<.001) and sequential pattern of service delivery (r=.39, p<.05). Greater dependence on vertical funding corresponds to greater external control (r=.43, p<.01). The prediction that, as scope narrows, task intensity (r=.56, p<.001), duration (r=.41, p<.01), and task volume (r=.50, p<.01) increase is upheld. Centrality and network size decrease together (r=.43, p<.01) where there is little reliance on vertical sources of funds (r=.36, p<.05). The integrated interorganizational model demonstrates some efficacy for testing potential effectiveness of networks.

Community Networks↗