Implications for Rural Health Care of Linkages with Urban Health Service Delivery Systems. UMN RHRC Working Paper #24.

Publication Date: June 1st, 1998
Publication Type(s): Working Paper
Author(s): Christianson, J., Wellever, A., Radcliff, T.

The consolidation of medical care delivery in urban areas has been extensively documented. Urban-based providers have increasingly linked together through formal organizational structures or contractual arrangements for the stated purposes of achieving greater efficiencies in service delivery, gaining leverage in contracting with managed care firms and self- insured employers, and accumulating the necessary financial resources to accept the risk inherent in some of these contracts (Walston, Kimberly, and Burns, 1996). Research on both the structure of such consolidated entities and on the impact of those entities on health care delivery at the community level is in its infancy. However, there is the strong presumption that these
systems will dominate health care delivery in most urban areas in the near future, and that they already have achieved that status in some communities.This paper draws upon data collected from twenty geographically dispersed, urban-based health delivery systems via mail surveys, telephone interviews, and focus groups. Part I discusses the existing literature on relationships between rural and urban providers and on the greater organizational integration of urban health care providers. Part II summarizes data collection methods and provides an overview of the characteristics of the twenty urban delivery systems that participated in this study.

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