Why integrated health networks have failed / Commentaries / Reply

Over the last two decades, hospitals, physicians, and nursing homes have rushed to merge or partner with one another, cheered on by consultants, academics, and experts who claimed that such networking was imperative for these organizations to survive in an increasingly competitive environment. In the 1990s, however, reports of the major difficulties encountered by the merged entities began to dampen the industry's enthusiasm for integration, causing some to even question the value of the integration "revolution." This article will review the primary rationale behind integration and will assess its success to date. Based on field reports and the available evidence, a study concludes that IHNS have not delivered on their promise. While each network should be considered in its unique market and contextual situation, the enormous financial, human, and clinical resources devoted to integration have not borne much fruit. Evidence of quantifiable, sustained financial or clinical value is scant. A number of commentaries about the study are also presented.