Public Policies, Private Policies, and the Organization of Physician Practice

Award Year:
Lawrence Casalino
Physician Practice Arrangements
Most policy efforts are directed toward patients' rights and trying to improve competition among HMOs. While physician practice organization and physician-health plan relationships are beginning to receive more attention, there has not yet been a systematic study of the institutional effects on these fundamental components of medical care. Dr. Casalino develops a conceptual framework to study public policy and public and private purchasing decisions and their effects on physician practice organization and physician-health plan relationships. With concepts adapted from institutional sociology to identify and classify public and private policies, he describes the effects of such decisions in 13 metropolitan areas, the 12 sites of the Community Tracking Study of the Center for Studying Health System Change plus Minneapolis, which has an unusual physician-employer coalition direct contracting model. By identifying the interaction among purchasers and providers, the project's results will provide information about the effects of proposed policy changes on organizations and may help to reduce unintended consequences.