title: Cooperation for a competitive position: The impact of hospital cooperation behavior on organizational performance.
abstract: BACKGROUND
  Several public policy initiatives, particularly those involving managed care, aim to enhance cooperation between partners in the health care sector because it is expected that such cooperation will reduce costs and generate additional revenue. However, empirical evidence regarding the effects of cooperation on hospital performance is scarce, particularly with respect to creating a comprehensive measure of cooperation behavior.
  
  
  OBJECTIVE
  The aim of this study is to investigate the impact of hospital cooperation behavior on organizational performance. We differentiate between horizontal and vertical cooperation using two alternative measures-cooperation depth and cooperation breadth-and include the interaction effects between both cooperation directions.
  
  
  METHODS
  Data are derived from a survey of German hospitals and combined with objective performance information from annual financial statements. Generalized linear regression models are used.
  
  
  RESULTS
  The study findings provide insight into the nature of hospitals' cooperation behavior. In particular, we show that there are negative synergies between horizontal administrative cooperation behavior and vertical cooperation behavior. Whereas the depth and breadth of horizontal administrative cooperation positively affect financial performance (when there is no vertical cooperation), vertical cooperation positively affects financial performance (when there is no horizontal administrative cooperation) only when cooperation is broad (rather than deep).
  
  
  CONCLUSIONS
  Horizontal cooperation is generally more effective than vertical cooperation at improving financial performance. Hospital managers should consider the negative interaction effect when making decisions about whether to recommend a cooperative relationship in a horizontal or vertical direction. In addition, managers should be aware of the limited financial benefit of cooperation behavior.
authors: Vera Antonia Büchner, MA, is Research Fellow in the Hamburg Center for Health Economics, Universität Hamburg, Germany. Vera Hinz, PhD, is Professor in the Hamburg Center for Health Economics, Universität Hamburg, Germany. Jonas Schreyögg, PhD, is Professor in the Hamburg Center for Health Economics, Universität Hamburg, Germany. E-mail: Jonas.Schreyoegg@wiso.uni-hamburg.de.
authors: Vera Antonia
authors: VA
authors: Büchner
authors: Vera
authors: V
authors: Hinz
authors: Jonas
authors: J
authors: Schreyögg
mesh_terms: D003299:Cooperative Behavior; D005858:Germany; D006739:Hospital Administration; D006755:Hospital Shared Services / Q000458:organization & administration*; D006801:Humans; D033183:Interdisciplinary Communication; D009313:National Health Programs; D058996:Quality Improvement / Q000458:organization & administration*