TY  - JOUR
AU  - Cebul,Randall D.
AU  - Rebitzer,James B.
AU  - Taylor,Lowell J.
AU  - Votruba,Mark
TI  - Organizational Fragmentation and Care Quality in the U.S. Health Care System
JF  - National Bureau of Economic Research Working Paper Series
VL  - No. 14212
PY  - 2008
Y2  - August 2008
UR  - http://www.nber.org/papers/w14212
L1  - http://www.nber.org/papers/w14212.pdf
N1  - Author contact info:
Randall Cebul
Professor of Medicine, Epidemiology,
and Biostatistics
Director, Center for Health Care
Research & Policy
School of Medicine
Case Western Reserve University
E-Mail: rdc@case.edu

James B. Rebitzer
John R. Mannix Medical Mutual Professor
Weatherhead School of Management,
Case Western Reserve University
11119 Bellflower Rd
Peter B. Lewis Building, Room 274
Cleveland, OH 44106-7235
Tel: 216/368-5537
Fax: NA
E-Mail: james.rebitzer@case.edu

Lowell Taylor
The Heinz School
Carnegie Mellon University
5000 Forbes Avenue
Pittsburgh, PA  15213-3890
E-Mail: lt20@andrew.cmu.edu

Mark Votruba
Weatherhead School of Management
Case Western Reserve University
11119 Bellflower Road
Cleveland, OH 44106
Tel: 216-368-4296
Fax: 216-368-5039
E-Mail: mark.votruba@case.edu
AB  - 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. 
ER  -