Health Facility Mergers: Some Conceptualizations

Health facility mergers and combinations are discussed, using several different classification schemes. These are based on analysis of 53 published reports of health facility mergers, review of the literature on enterprise consolidations in the business world, and the application of relevant organization theory. These classifications are of two types. The first defines health service integrations as static arrangements. Seven "dimensions" are identified: organizational pattern, legal bonds, nature of combined services, stages and forms of production, geography of population served, facility location, and organizational impact. The second presents health facility combinations as a merging process, emphasizing the dynamic state of health organizations and the important dimension of time. Seventy-two reported variables are grouped into five stages of the merging process. These conceptualizations are "middle range" attempts to bring together the worlds of theory and practice in ways which help explain the dynamics of inter-organizational relationships among health facilities, and contribute to systematic approaches to both further research and policy development concerning the rationalization of health care delivery systems.