title: Provider accountability as a driving force towards physician-hospital integration: a systematic review.
abstract: BACKGROUND
  Hospitals and physicians lie at the heart of our health care delivery system. In general, physicians provide medical care and hospitals the resources to deliver health care. In the past two decades many countries have adopted reforms in which provider financial risk bearing is increased. By making providers financially accountable for the delivered care integrated care delivery is stimulated.
  
  
  OBJECTIVE
  To assess the evidence base supporting the relationship between provider financial risk bearing and physician-hospital integration and to identify the different types of methods used to measure physician-hospital integration to evaluate the functional value of these integrative models.
  
  
  RESULTS
  Nine studies met the inclusion criteria. The evidence base is mixed and inconclusive. Our methodological analysis of previous research shows that previous studies have largely focused on the formal structures of physician-hospital arrangements as an indicator of physician-hospital integration.
  
  
  CONCLUSIONS
  The link between provider financial risk bearing and physician-hospital integration can at this time be supported merely on the basis of theoretical insights of agency theory rather than empirical research. Physician-hospital integration measurement has concentrated on the prevalence of contracting vehicles that enables joint bargaining in a managed care environment but without realizing integration and cooperation between hospital and physicians. Therefore, we argue that these studies fail to shed light on the impact of risk shifting on the hospital-physician relationship accurately.
authors.affiliation: Ghent University, Ghent, Belgium.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Trybou
authors.affiliation: Department of Management, Innovation & Entrepreneurship, Ghent University, Ghent, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Gemmel
authors.affiliation: Department of Public Health, Ghent University, Ghent, Belgium.
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
keywords: literature review; methods; physician–hospital integration; provider financial risk bearing