Physician-Hospital Integration and Healthcare Quality

In my research project I have decided to look at physician-hospital integration’s effect on the quality of care provided.  When physicians and hospitals work together it can greatly affect patients.  If physicians and hospitals are not competing but instead acting as one organization, the decrease in healthcare market competition means that organizations can increase prices without fear of another organization charging less.  Not all effects of the integration are negative, however.  If hospitals and physicians are working together, they can more easily purchase expensive technologies that improve patient care.  For example, physicians in solo practice can’t afford to have digital medical records, but large, integrated organizations can easily purchase and implement this expensive technology to improve the quality and efficiency of healthcare.  I wanted to find out how integrated organizations affect patients, so I decided that the greatest affect a physician-hospital relation could have on patients is in terms of healthcare quality.

Quality of care is difficult to empirically measure; how do you quantify the quality of care a physician provides?  Good doctors don’t have the most touchdowns or the highest on base percentage like a great quarterback or outfielder, and they don’t necessarily see the most patients.  A physician that is very clever might be able to diagnose quickly, but so might a physician who is lazy and doesn’t really care about his or her patients.  Some studies I read looked at the percent of patients that received a specific procedure, or looked at mortality rates of patients a year after a heart attack.  This type of data has two problems, though.  It is difficult to obtain, and it is expensive.  For a project that is done in one summer, it would be difficult to do a follow up a year later.  At Professor Jennifer Mellor’s suggestion, I decided to get my data from the Community Tracking Study Physician Survey (CTS-PS). This survey had physicians answer a number of questions about their employer, their compensation, and most importantly their ability to provide quality care.  These include questions like “Do you have adequate time with your patients,” and “Do you have clinical freedom?” which physicians answer as either agree strongly, agree somewhat, disagree somewhat, or disagree strongly.  While self-reported quality is not perfect, there should be information to get a better picture of how physician-hospital integration affects the care patients receive.