title: A mechanism of institutional isomorphism in referral networks among hospitals in Seoul, South Korea.
abstract: Hospitals engage in medical referral system relations voluntarily, by virtue of their own service capacities. These capacities include medical technology, equipment supply, and patient management, which are assessed individually by medical institutions in efforts to control costs and maintain efficiency in tertiary hospitals. This study assessed referral networks according to the institutional isomorphism theory of new economic sociology. As a result, the referral networks were shown to exhibit emergent structural hierarchy via cumulative clustering by established year and were not affected by attributive variables such as region, bed number, and year of establishment. In particular, the networks evidenced institutional isomorphism with certain central hospitals. As a consequence, personal indices were shown to decrease in accordance with its period, and only the structural index increased. Normative pressures cause organizations to become hierarchically homogenized, in accordance with the principle of organizational learning in specialized fields. Therefore, normative isomorphism on the basis of public domains should be considered an inherent factor in the development of referral networks.
authors.affiliation: Department of Healthcare Management and Policy, School of Public Health, Seoul National University, San 1, Seoul, South Korea.
authors.forename: Minsoo
authors.initials: M
authors.lastname: Jung
authors.forename: Mankyu
authors.initials: M
authors.lastname: Choi
mesh_terms: D016009:Chi-Square Distribution; D003068:Coercion; D003299:Cooperative Behavior; D017598:Efficiency, Organizational; D006276:Health Facility Size; D006302:Health Services Research; D006739:Hospital Administration / Q000379:methods / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000458:organization & administration*; D006801:Humans; D007373:Interinstitutional Relations; D016015:Logistic Models; D008389:Marketing of Health Services; D017146:Models, Organizational; D015279:Organizational Culture; D009937:Organizational Objectives; D016134:Organizational Policy; D012017:Referral and Consultation / Q000458:organization & administration*; D056910:Republic of Korea; D012962:Sociology, Medical