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The Ties That Bind: Interorganizational Linkages and Physician-System Alignment

Alexander, Jeffrey A. PhD,*; Waters, Teresa M. PhD,†; Burns, Lawton R. PhD,‡; Shortell, Stephen M. PhD; Gillies, Robin R. PhD; Budetti, Peter P. MD, JD; Zuckerman, Howard S. PhD


Objectives. To examine the association between the degree of alignment between physicians and health care systems, and interorganizational linkages between physician groups and health care systems.

Methods. The study used a cross sectional, comparative analysis using a sample of 1,279 physicians practicing in loosely affiliated arrangements and 1,781 physicians in 61 groups closely affiliated with 14 vertically integrated health systems. Measures of physician alignment were based on multiitem scales validated in previous studies and derived from surveys sent to individual physicians. Measures of interorganizational linkages were specified at the institutional, administrative, and technical core levels of the physician group and were developed from surveys sent to the administrator of each of the 61 physician groups in the sample. Two stage Heckman models with fixed effects adjustments in the second stage were used to correct for sample selection and clustering respectively.

Results. After accounting for sample selection, fixed effects, and group and individual controls, physicians in groups with more valued practice service linkages display consistently higher alignment with systems than physicians in groups that have fewer such linkages. Results also suggest that centralized administrative control lowers physician-system alignment for selected measures of alignment. Governance interlocks exhibited only weak associations with alignment.

Conclusions. Our findings suggest that alignment generally follows resource exchanges that promote value-added contributions to physicians and physician groups while preserving control and authority within the group.

*From the School of Public Health, University of Michigan, Ann Arbor.

†From the Center for Health Services Research, University of Tennessee, Health Science Center, Memphis.

‡From the Wharton School of the University of Pennsylvania, Philadelphia.

§From the School of Public Health, University of California, Berkeley.

¶From the Institute for Health Services Research and Policy Studies, Northwestern University, Evanston and Chicago, Illinois.

∥From the School of Public Health, University of Washington, Seattle.

Send correspondence and reprint requests to: Jeffrey A. Alexander, PhD, Department of Health Management and Policy, School of Public Health, University of Michigan, 1420 Washington Heights, Ann Arbor, MI 48109

© 2001 Lippincott Williams & Wilkins, Inc.