title: Understanding competition between healthcare providers: Introducing an intermediary inter-organizational perspective.
abstract: Pro-competitive policy reforms have been introduced in several countries, attempting to contain increasing healthcare costs. Yet, research proves ambiguous when it comes to the effect of competition in healthcare, with a number of studies highlighting unintended and unwanted effects. We argue that current empirical work overlooks the role of inter-organizational relations as well as the interplay between policy at macro level, inter-organizational networks at meso level, and outcomes at micro level. To bridge this gap and stimulate a more detailed understanding of the effect of competition in health care, this article introduces a cross-level conceptual framework which emphasizes the intermediary role of cooperative inter-organizational relations at meso level. We discuss how patient transfers, specialist affiliations, and interlocking directorates constitute three forms of inter-organizational relations in health care which can be used within this framework. The paper concludes by deriving several propositions from the framework which can guide future research.
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. Electronic address: d.westra@maastrichtuniversity.nl.
authors.forename: Daan
authors.initials: D
authors.lastname: Westra
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. Electronic address: federica.angeli@maastrichtuniversity.nl.
authors.forename: Federica
authors.initials: F
authors.lastname: Angeli
authors.affiliation: Department of Organisation and Strategy, School of Business and Economics, Maastricht University, Maastricht, The Netherlands. Electronic address: m.carree@maastrichtuniversity.nl.
authors.forename: Martin
authors.initials: M
authors.lastname: Carree
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. Electronic address: d.ruwaard@maastrichtuniversity.nl.
authors.forename: Dirk
authors.initials: D
authors.lastname: Ruwaard
mesh_terms: D003299:Cooperative Behavior; D004465:Economic Competition; D018166:Health Care Reform; D006282:Health Personnel / Q000191:economics*; D006801:Humans; D018854:Managed Competition; D017146:Models, Organizational; D009936:Organizational Innovation
keywords: Health outcomes; Inter-organizational cooperation; Inter-organizational networks; Managed competition; Market structure; Pro-competitive reform