For-Profit Enterprise in Health Care

The once dominant structure of community not-for-profit hospitals and their independent, largely solo-practitioner medical staffs are being challenged by new models of care.

Abstract

Health care is undergoing a major and often troubling transition. The once dominant structure of community not-for-profit hospitals and their independent, largely solo-practitioner medical staffs has undergone many organizational transformations. Multi-institutional systems have proliferated. Solo medical practitioners have become the exception, and a wave of physician entrepreneurship, often involving economic arrangements with health care institutions, has provoked concern about conflict of interest and fiduciary responsibility. New types of entities, ranging from ambulatory care centers to preferred provider organizations, have been created. Old boundaries are blurring as organizations increasingly provide different levels of care, become involved in both financing and providing . . .