| The positing of different ideas regarding how to structure the healthcare field in order to provide accessible quality care created a firestorm of debate among policy makers more than fifty-years ago. This debate continues with no signs of abatement in the near future. While scholarly research specializing in healthcare organizations continues to flourish, no clear solutions have been provided as scholars remain highly fragmented. This fragmentation has partially been caused by a paucity of population-level data. This lack of empirical evidence contributed to the divisive rift among healthcare scholars which has largely been focused on disparate theoretical frameworks. Among these frameworks, two dominant paradigms have emerged, with one suggesting that integration is influenced by the market environment and the other asserting the institution plays a key role. Although the frameworks are distinctive, theorists suggest that integration will lead to improved access, utilization, and quality of care; however, there is little research assessing these outcomes. In order to understand the full picture of integration, specifically physician-hospital integration and how it impacts healthcare utilization and quality, rigorous tests of these theoretical perspectives must be undertaken.;This research brings together two theoretical frameworks to investigate how each framework influences levels of physician-hospital integration and how such integration influences healthcare utilization and quality of care creating a continuum in healthcare organizations research. The following questions are examined: 1) How do markets and institutions interact to influence physician-hospital integration? 2) How does physician-hospital integration impact healthcare utilization? and 3) How does physician-hospital integration impact quality of care? Using publicly available data from a variety of sources, the results suggest that both theoretical frameworks explain variations in physician-hospital integration across metropolitan areas; the impact of physician-hospital integration on healthcare utilization varies with only select types of integration improving healthcare utilization; and physician-hospital integration has a minor impact on quality of care with only select types of integration influencing quality outcomes. Overall, these findings suggest that both environments and institutions play important roles in the formation of physician-hospital relationships. Moreover, these relationships ultimately influence healthcare outcomes. |
