A study to document the development and management of multi-institutional arrangements in the delivery of health care services

Abstract

The problem addressed in this study is the lack of comprehensive structured information on the historical development, the variety of forms, and the direction in change of multi-institutional arrangements in health services delivery. A definition of "multi-institutional arrangements" is developed and major studies in the field are reviewed. The historical development worldwide of multi-institutional arrangements in health care services from the mid-18th century to early 1982 is documented as a basis for the presentation of a taxonomy of multi-institutional arrangements. The taxonomy is composed of five levels of increasingly complex inter-organizational forms. The first level, "individual institutional corporate restructuring," typically a hospital, fragments from one corporate entity to several, all owned by a single corporation. Level two, "institutional sponsored cooperation," occurs when individual health care institutions sponsor or coordinate services and/or projects in order to achieve administrative goals and objectives. The third level, multi-institutional health care systems, occur when individual institutions, often of a homogeneous nature, affiliate or cooperate (usually within a system) in order to achieve economies of scale and/or administrative goals and objectives. Linked regional health care systems, the fourth level of the taxonomy, occurs when systems, such as multi-hospital systems, cooperate in order to achieve economies of scale and/or to accomplish administrative goals and objectives. The fifth level of the taxonomy, international health care systems, occur when linked regional health care systems cooperate in order to achieve administrative and/or political goals and objectives. The study presents a discussion of significant management and service issues for each level of the taxonomy in order to document experience from the field with the various organizational forms and to provide information for others who may attempt to develop their own such organizations or to study them. The study concludes that multi-institutional arrangements in health will continue to develop in response primarily to economic or political pressures, the rate and form of development, and being sensitive to the organizational, political, economic, and social environment.