Working Paper: NBER ID: w14212
Authors: Randall D. Cebul; James B. Rebitzer; Lowell J. Taylor; Mark Votruba
Abstract: Many goods and services can be readily provided through a series of unconnected transactions, but in health care close coordination over time and within care episodes improves both health outcomes and efficiency. Close coordination is problematic in the US health care system because the financing and delivery of care is distributed across a variety of distinct and often competing entities, each with its own objectives, obligations and capabilities. These fragmented organizational structures lead to disrupted relationships, poor information flows, and misaligned incentives that combine to degrade care quality and increase costs. We illustrate our argument with examples taken from the insurance and the hospital industries, and discuss possible responses to the problems resulting from organizational fragmentation.
Keywords: No keywords provided
JEL Codes: D2; I11; I12; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Fragmented organizational structures in the U.S. health care system (L22) | degraded care quality (I14) |
| Fragmented organizational structures in the U.S. health care system (L22) | increased costs (J32) |
| High turnover rates in health insurance relationships (I11) | inadequate preventive care (I14) |
| High turnover rates in health insurance relationships (I11) | significant gaps in care quality (I24) |
| Fragmented structure of hospitals (I11) | inhibits key clinical process improvements (O31) |
| Independence of physicians from hospital management (I11) | fragmented structure of hospitals (I19) |
| Lack of fully interoperable electronic medical record system (I19) | fragmented organizational structures (L22) |
| Lack of fully interoperable electronic medical record system (I19) | limits flow of information necessary for high-quality care (I13) |
| Responses to organizational fragmentation (L22) | enhance care quality and efficiency (I11) |