title: How big should an integrated health care delivery system be at an academic medical center?
abstract: The author defines integrated health care delivery systems and comments that there are few such systems now but many in various stages of development. The size of such a system can be described in terms of the number of patients it serves, including their health status and utilization of care, the geographic configuration of the served area, the number of physicians, and the scope and extent of the facilities network. There are a variety of factors that influence a system's size; the author concentrates on the factors that an academic medical center must consider when formulating system-size goals. He discusses (1) the influence of how the institution structures itself to survive; (2) the effects of technology, innovation, and health care costs on the size and organization of these systems; and (3) the effects of the specific characteristics of the institutions' missions of education, research, and patient care. Real numbers describing integrated systems are presented as they relate to three possible institutional goals: economic viability, academic viability, and academic leadership. The author explains why academic medical centers should not try to be only tertiary or quaternary care providers for other integrated health care delivery systems, but at the same time emphasizes that there is no easy or inexpensive way for centers to develop their own systems. Alternative structures for integrated systems are discussed, such as "disease management systems" being developed by the pharmaceutical industry, an "end-to-end linkage" approach, and various ideas to include "captive markets," such as prisoners, university students, and members of communities for the elderly.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Medicine, University of Alabama at Birmingham 35294-0110, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Lewis
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D004501:Education, Medical; D017048:Health Care Costs; D006801:Humans; D008511:Medicine; D018802:Patient-Centered Care; D012106:Research; D013038:Specialization; D014481:United States