Abstract
Pro-competitive policy reforms have been introduced in several countries, attempting to contain increasing healthcare costs. Yet, research proves ambiguous when it comes to the effect of competition in healthcare, with a number of studies highlighting unintended and unwanted effects. We argue that current empirical work overlooks the role of inter-organizational relations as well as the interplay between policy at macro level, inter-organizational networks at meso level, and outcomes at micro level. To bridge this gap and stimulate a more detailed understanding of the effect of competition in health care, this article introduces a cross-level conceptual framework which emphasizes the intermediary role of cooperative inter-organizational relations at meso level. We discuss how patient transfers, specialist affiliations, and interlocking directorates constitute three forms of inter-organizational relations in health care which can be used within this framework. The paper concludes by deriving several propositions from the framework which can guide future research.
Original language | English |
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Pages (from-to) | 149-157 |
Number of pages | 9 |
Journal | Health Policy |
Volume | 121 |
Issue number | 2 |
DOIs | |
Publication status | Published - Feb 2017 |
Keywords
- Pro-competitive reform
- Managed competition
- Inter-organizational networks
- Inter-organizational cooperation
- Market structure
- Health outcomes
- QUALITY-OF-CARE
- MANAGED-COMPETITION
- HOSPITAL COMPETITION
- INTERHOSPITAL COLLABORATION
- INSTITUTIONAL RESPONSE
- PATIENT-TRANSFERS
- NETWORKS
- REFORM
- NETHERLANDS
- MORTALITY