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Understanding competition between healthcare providers: Introducing an intermediary inter-organizational perspective

Daan Westra, Federica Angeli, Martin Carree and Dirk Ruwaard

Health Policy, 2017, vol. 121, issue 2, 149-157

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.

Keywords: Pro-competitive reform; Managed competition; Inter-organizational networks; Inter-organizational cooperation; Market structure; Health outcomes (search for similar items in EconPapers)
Date: 2017
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