THE CHANGING CONFIGURATION OF HEALTH ORGANIZATIONS: REVISITING THE TAXONOMY OF HEALTH NETWORKS AND SYSTEMS.

This paper revisits the 1994 taxonomy of health networks and systems in order to: a) assess how the original cluster categories of hospital-led health networks and systems have changed over time; and b) identify any new patterns of cluster configurations. With data from the 1998 American Hospital Association Annual Survey of Hospitals, we analyze a sample of 216 networks and 342 systems. The study design replicates the original taxonomy development. As before, separate cluster solutions are identified for health networks and health systems by applying three strategic/structural dimensions (differentiation, integration, and centralization) to three components of the health service/product continuum (hospital services, physician arrangements, and provider-based insurance activities). The cluster categories that emerge in the revised taxonomy are recognizable from the original, however, they reveal some new organizational configurations. For the health networks, the results suggest that independent hospital and decentralized forms persist, but that centralization of product/service lines is occurring more selectively than in the past. For the health systems, the independent hospital and centralized categories also persist but, at the same time, participation has grown in and dispersed across a more diverse set of decentralized organizational forms. In addition, for both networks and systems, the definition of centralization has changed over the five years since the original taxonomy. We discuss explanations and implications specific to these findings and conclude with a consideration of the continued value of the taxonomy more broadly.