The effects of managed care on physician and clinical integration in hospitals

OBJECTIVE. TO empirically estimate the effects Chat managed care has had on physician and clinical integration in urban hospitals. DATA SOURCES. The 1993 Hospital-Physician Relationship Survey conducted for the Prospective Payment Assessment Commission, augmented with data from a variety of secondary sources. The entire 1,495 responding hospitals were us ed to construct measures of integration; 591 responding hospitals in urban areas were used for the managed care analysis. STUDY DESIGN. Factor analysis was used to reduce 23 integration variables i nto 5 physician and 3 clinical integration factors. Two-stage least-squares regression techniques were used to estimate the effects of endogenous mana ged care. Models were estimated for all urban hospitals and for hospital su bsets based upon ownership, multi-hospital system status, and teaching. PRINCIPAL FINDINGS. Other things equal, physician involvement in hospital m anagement and governance increased with managed care involvement; to a less or degree, the use of physician organization arrangements and other joint v entures also increased. Practice management and support services were lower in hospitals with high managed care activity. Larger hospitals, investor o wned, system, and non-teaching hospitals had larger managed care revenues. Managed care revenues were lower in more concentrated hospital markets. CONCLUSIONS. The relationship between managed care and physician and clinic al integration is relatively modest. Much of the realignment under managed care has been limited to certain types of efforts. Those efforts can best b e described as foundation-building rather than comprehensive or fundamental .