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Defining Health Systems

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The first step in studying health systems is to develop a definition of what constitutes a “health system,” which is predicted to evolve over time.

Below, each Center of Excellence has contributed its own definition as a start line , as has AHRQ and therefore the Coordinating Center, which it wont to develop the Compendium of U.S. Health Systems, 2016.

Dartmouth College Center of Excellence’s Definition of a Health System

The Dartmouth College Center of Excellence defines a health system as a corporation that consists of either a minimum of one hospital plus a minimum of one group of physicians or quite one group of physicians. For the needs of this definition, the group of physicians must include a minimum of three medical care physicians. Dartmouth is studying multiple levels within a system: individual practices, hospitals, and system leadership.

Dartmouth has identified systems and their component entities by watching the formal corporate relationship among the entities. While independent practices and independent hospitals don’t meet the definition of a system, Dartmouth is additionally studying these entities.

NBER Center of Excellence’s Definition of a Health System

The National Bureau of Economic Research (NBER) Center of Excellence defines health system supported three sorts of arrangements between two or more health care provider organizations: (1) organizations with common ownership, (2) contractually integrated organizations (e.g., accountable care organizations), and (3) informal care systems, like common referral arrangements.

Systems include organizations combined horizontally (e.g., a hospital system) or vertically (e.g., a multihospital system also owning physician practices and post-acute care facilities).

RAND Center of Excellence’s Definition of a Health System

The RAND Center of Excellence defines a health system as two or more health care organizations affiliated with one another through shared ownership or a contracting relationship for payment and repair delivery. For its work, a health system must have a minimum of one acute care hospital and a minimum of one physician organization. For RAND, this excludes “horizontally integrated” health systems, like systems consisting only of hospitals. Notably, organizations are often members of multiple health systems, like a physician organization that participates in additional than one accountable care organization.

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Definition of a Health System utilized in AHRQ’s Compendium of U.S. Health Systems, 2016

The Compendium of U.S. Health Systems, 2016, defines a health system as a corporation that has a minimum of one hospital and a minimum of one group of physicians that gives comprehensive care (including primary and specialty care) who are connected with one another and with the hospital through common ownership or joint management.

Under this definition, foundation models are considered a sort of joint management, while joint participation among providers in an accountable care organization isn’t , by itself, indicative of joint management.

“Group” isn’t synonymous with a separately organized medical group; hospitals that employ community-based physicians who provide comprehensive care (but aren’t organized as a medical group) are considered health systems under this definition.

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