Background: Previous empirical and managerial studies have ignored the effectiveness of integrated health networks. It has been argued that the varying definitions and strategic imperatives of integrated organizations may have complicated the assessment of the outcomes/performance of varying models, particularly when their market structures and contexts differed.
Purposes: This study aimed to empirically verify a theoretical perspective on the coordination infrastructure designs and the effectiveness of the primary community care networks (PCCNs) formed and funded by the Bureau of National Health Insurance since March 2003. The PCCNs present a model to replace the traditional fragmented providers in Taiwan's health care.
Methodology/Approach: The study used a cross-sectional mailed survey designed to ascertain partnership coordination infrastructure and integration of governance, clinical care, bonding, finances, and information. The outcome indicators were PCCNs' perceived performance and willingness to remain within the network. Structural equation modeling examined the causal relationships, controlling for organizational and environmental factors. Primary data collection occurred from February through December 2005, via structured questionnaires sent to 172 PCCNs.
Findings: Using the individual PCCN as the unit of analysis, the results found that a network's efforts regarding coordination infrastructures were positively related to the PCCN's perceived performance and willingness to remain within the network. In addition, PCCNs practicing in rural areas and in areas with higher density of medical resources had better perceived effectiveness and willingness to cooperate in the network.
Practical Implication: The lack of both an operational definition and an information about system-wide integration may have obstructed understanding of integrated health networks' organizational dynamics. This study empirically examined individual PCCNs and offers new insights on how to improve networks' organizational design and effectiveness.
Blossom Yen-Ju Lin, PhD, is Associate Professor, School and Graduate Institute of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan. E-mail: firstname.lastname@example.org.
Yung-Kai Lin, MD, MBA, is Attending Physician, Division of Cardiovascular Surgery, Taichung Veterans General Hospital, Taiwan.
Cheng-Chieh Lin, MD, PhD,is Dean, Professor, College of Medicine, China Medical University, Taichung, Taiwan; Professor, School and Graduate Institute of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan; Professor, Consultant, Attending Physician, Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; and Professor, Institute of Health Care Administration, College of Health Science, Asia University, Taichung, Taiwan.
This project was supported by grants from the Taiwan National Science Council (NSC-94-2416-H-039-001-SSS).