Internet infrastructures and health care systems: a qualitative comparative analysis on networks and markets in the British National Health Service and Kaiser Permanente.
BACKGROUND
The Internet and emergent telecommunications infrastructures are transforming the future of health care management. The costs of health care delivery systems, products, and services continue to rise everywhere, but performance of health care delivery is associated with institutional and ideological considerations as well as availability of financial and technological resources.


OBJECTIVE
to identify the effects of ideological differences on health care market infrastructures including the Internet and telecommunications technologies by a comparative case analysis of two large health care organizations: the British National Health Service and the California-based Kaiser Permanente health maintenance organization.


METHODS
A qualitative comparative analysis focusing on the British National Health Service and the Kaiser Permanente health maintenance organization to show how system infrastructures vary according to market dynamics dominated by health care institutions ("push") or by consumer demand ("pull"). System control mechanisms may be technologically embedded, institutional, or behavioral.


RESULTS
The analysis suggests that telecommunications technologies and the Internet may contribute significantly to health care system performance in a context of ideological diversity.


CONCLUSIONS
The study offers evidence to validate alternative models of health care governance: the national constitution model, and the enterprise business contract model. This evidence also suggests important questions for health care policy makers as well as researchers in telecommunications, organizational theory, and health care management.
Séror
Ann C
AC
Faculté des Sciences de l'Administration, Université Laval, Ste.-Foy, Québec, Canada. ann.seror@mng.ulaval.ca
D003195:Computer Communication Networks / Q000458:organization & administration / Q000592:standards*; D003695:Delivery of Health Care / Q000592:standards*; D019981:Health Care Sector / Q000458:organization & administration / Q000592:standards*; D006279:Health Maintenance Organizations / Q000592:standards*; D006801:Humans; D020407:Internet / Q000458:organization & administration / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D013222:State Medicine / Q000592:standards*; D006113:United Kingdom