Hospital-physician collaboration: landscape of economic integration and impact on clinical integration.
BACKGROUND
Hospital-physician relationships (HPRs) are an important area of academic research, given their impact on hospitals' financial success. HPRs also are at the center of several federal policy proposals such as gain sharing, bundled payments, and pay-for-performance (P4P).


METHODS
This article analyzes the HPRs that focus on the economic integration of hospitals and physicians and the goals that HPRs are designed to achieve. It then reviews the literature on the impact of HPRs on cost, quality, and clinical integration.


RESULTS
The goals of the two parties in HPRs overlap only partly, and their primary aim is not reducing cost or improving quality. The evidence base for the impact of many models of economic integration is either weak or nonexistent, with only a few models of economic integration having robust effects. The relationship between economic and clinical integration also is weak and inconsistent. There are several possible reasons for this weak linkage and many barriers to further integration between hospitals and physicians.


CONCLUSIONS
Successful HPRs may require better financial conditions for physicians, internal changes to clinical operations, application of behavioral skills to the management of HPRs, changes in how providers are paid, and systemic changes encompassing several types of integration simultaneously.
Burns
Lawton Robert
LR
Wharton Center for Health Management and Economics, Wharton School, University of Pennsylvania, Philadelphia, PA 19104-6218, USA. burnsL@wharton.upenn.edu
Muller
Ralph W
RW
D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000191:economics*; D017598:Efficiency, Organizational / Q000191:economics*; D006759:Hospital-Physician Joint Ventures / Q000191:economics*; D018578:Hospital-Physician Relations; D006801:Humans; D007400:Interprofessional Relations; D008389:Marketing of Health Services / Q000458:organization & administration; D010816:Physician Incentive Plans / Q000191:economics*; D019984:Quality Indicators, Health Care / Q000191:economics; D014481:United States
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