Organizational Fragmentation and Care Quality in the U.S. Health Care System

37 Pages Posted: 18 Aug 2008 Last revised: 14 Jul 2009

See all articles by Randall Cebul

Randall Cebul

Case Western Reserve University - Center for Health Care Research and Policy

James B. Rebitzer

Boston University School of Management; National Bureau of Economic Research (NBER); IZA Institute of Labor Economics; Bard College - The Levy Economics Institute

Lowell J. Taylor

Carnegie Mellon University - H. John Heinz III School of Public Policy and Management

Mark Votruba

Case Western Reserve University - Weatherhead School of Management

Date Written: August 2008

Abstract

Many goods and services can be readily provided through a series of unconnected transactions, but in health care close coordination over time and within care episodes improves both health outcomes and efficiency. Close coordination is problematic in the US health care system because the financing and delivery of care is distributed across a variety of distinct and often competing entities, each with its own objectives, obligations and capabilities. These fragmented organizational structures lead to disrupted relationships, poor information flows, and misaligned incentives that combine to degrade care quality and increase costs. We illustrate our argument with examples taken from the insurance and the hospital industries, and discuss possible responses to the problems resulting from organizational fragmentation.

Suggested Citation

Cebul, Randall and Rebitzer, James B. and Taylor, Lowell J. and Votruba, Mark, Organizational Fragmentation and Care Quality in the U.S. Health Care System (August 2008). NBER Working Paper No. w14212. Available at SSRN: https://ssrn.com/abstract=1230840

Randall Cebul

Case Western Reserve University - Center for Health Care Research and Policy ( email )

2500 MetroHealth Drive
Cleveland, OH 44109
United States

James B. Rebitzer (Contact Author)

Boston University School of Management ( email )

595 Commonwealth Avenue
Boston, MA MA 02215
United States
617 353 4605 (Phone)

National Bureau of Economic Research (NBER)

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

IZA Institute of Labor Economics

P.O. Box 7240
Bonn, D-53072
Germany

Bard College - The Levy Economics Institute

Blithewood
Annandale-on-Hudson, NY 12504
United States

Lowell J. Taylor

Carnegie Mellon University - H. John Heinz III School of Public Policy and Management ( email )

Pittsburgh, PA 15213-3890
United States
412-268-3278 (Phone)
412-268-7036 (Fax)

Mark Votruba

Case Western Reserve University - Weatherhead School of Management ( email )

10900 Euclid Ave.
Cleveland, OH 44106-7235
United States

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