This article introduces a new ecological approach to the study of form emergence based on the notion of an organizational community—a bounded set of forms with related identities. Applying the approach to 48 organizational forms in the health care sector, this study suggests that the development of novel forms is affected by the positioning of their identities with respect to existing form identities in the community, by the aggregate density and size of organizations matching those existing identities, and by the amount of attention directed at identity attributes by sector participants. Findings show that the process of form emergence is subject to population‐dependent effects akin to those noted previously for organizational entries within established populations. The aggregate density and size of organizations with similar identities increase the probability of form emergence to a point (cross‐form legitimation), but highly saturated regions of the identity space tend to be uninviting to new forms (cr...

The Emergence of Organizational Forms: A Community Ecology Approach1

America's private and public third-party payers, squeezed by health care costs that continue to soar at rates well above inflation, are persuaded that "managed care" plans will produce demonstrable savings as compared with the current cost trends of traditional fee-for-service medicine. They are accelerating their efforts to promote plans that integrate the delivery and financing of care and that apply new constraints on encounters between physicians and patients. The key constraint for doctors is the limitation placed on the autonomy of their clinical decisions. The constraint for patients is the requirement that they see only physicians who are members of . . .

The American health care system. Managed care.

Politics, for better or worse, plays a critical role in health affairs. The purpose of this article is to articulate a role for political analysis of public health issues, ranging from injury and disease prevention to health care reform. It begins by examining how health problems make it onto the policy agenda. Perceptions regarding the severity of the problem, responsibility for the problem, and affected populations all influence governmental responses. Next, it considers how bounded rationality, fragmented political institutions, resistance from concentrated interests, and fiscal constraints usually lead political leaders to adopt incremental policy changes rather than comprehensive reforms even when faced with serious public health problems. It then identifies conditions under which larger-scale transformation of health policy can occur, focusing on critical junctures in policy development and the role of policy entrepreneurs in seizing opportunities for innovation. Finally, it reviews the challenges confronting officials and agencies who are responsible for implementing and administering health policies. Public health professionals who understand the political dimensions of health policy can conduct more realistic research and evaluation, better anticipate opportunities as well as constraints on governmental action, and design more effective policies and programs.

https://www.annualreviews.org/doi/pdf/10.1146/annurev.publhealth.25.101802.123126

The politics of public health policy.

The effect of market structure on HMO premiums.

This study examined organizational adaptation to a radical environmental shift—a dramatic change in federal policies toward health maintenance organizations (HMOs) that removed key advantages of no...

Converting to For-Profit Status: Corporate Responsiveness to Radical Change

Among various health cost containment strategies proposed during the 1970s, none has held more sustained fascination than the health maintenance organization (HMO). For many years, policy analysts in search of market- and incentive-based alternatives to command and control regulation have argued that medical groups combining prepayment and group practice, and offering comprehensive medical services within a fixed budget, would hold down costs both by their own efficient operations and by the competitive pressures they would apply to the conventional systems. During the 1970s, three presidents and five Congresses worked to formulate and implement legislation to increase the HMO presence nationwide, with very modest results. Some observers concluded that but for the well-intended but counterproductive efforts of the federal government, HMOs might thrive. Indeed, the Reagan administration has called for an end to direct federal financial involvement in building HMOsthough it has also promised legislation to promote HMOs and a newly competitive health care system based on revamped financial incentives and reinvigorated markets. In this book, Lawrence D. Brown, a senior fellow in the Brookings Governmental Studies program, examines the interplay between politics and policy in the federal HMO development effort between 1970 and 1980. He argues that the basic explanation for the disappointments of the policy analysts and federal supporters of HMOs lies not in a political miscarriage but in the overambitious promises of the policy strategy itself. Tracing the poor fit between policy and politics revealed by federal efforts to translate the attractive HMO idea into a workable strategy, Brown concludes that the episode augurs poorly for the competitive reforms frequently offered as a nonregulatory solution to rising health care costs in the 1980s."

Politics and Health Care Organization: Hmos As Federal Policy

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A desert menu

Lawrence D. Brown presents five case studies of cities that have promoted active living with varying success through a range of approaches. He shows how and why the transformation of a call for public intervention into projects, programs, and policies is inescapably political. 

Lawrence D. Brown

Papers

Politics and Health Care Organization: Hmos As Federal Policy

A desert menu

Political Exercise