The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
We focus on a number of topic areas identified by state health policy leaders as important to population health.
The Center for Evidence-based Policy at Oregon Health & Science University is a national leader in evidence-based decision making and policy design.
Keep up with news and updates from the Milbank Memorial Fund. Get the latest from thought leaders, including Christopher F. Koller, president of the Fund.
We publish The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to population health.
June 1994 (Volume 72)
June 1994 | James C. Robinson
The American hospital faces two different possible futures. In one, the hospital continues to expand into outpatient, home health, and long-term-care services and remains the center of the changing health care system. In the other, competition in each of these domains from independent health plans, which do not have to contend with the high wages, technological imperatives, and bureaucratic inertia of large hospital organizations, pushes the hospital to a peripheral role as provider of ever-diminishing acute inpatient services. The choice between these two futures will be made based on the efficiencies of vertical integration relative to market contracting. Transactions cost economics is used to analyze the changing boundaries of the hospital organization, particularly with respect to outpatient diagnostic and surgical clinics, home health agencies, and long-term-care facilities.
Author(s): James C. Robinson
Download the Article
Read on JSTOR
Volume 72, Issue 2 (pages 259–275)
Published in 1994
Privatization, System Membership, and Access to Home Health Care for the Elderly
Improving Health: Measuring Effects of Medical Care