The Impact of Organizational Boundaries on Healthcare Coordination and Utilization

We measure organizational concentration-the distribution of a patient's healthcare across organizations-to examine how firm boundaries affect healthcare efficiency. First, when patients move to regions where outpatient visits are typically concentrated within a small set of firms, their healthcare utilization falls. Second, for patients whose PCPs exit the market, switching to a PCP with 1 standard deviation higher organizational concentration reduces utilization by 21%. This finding is robust to controlling for the spread of healthcare across providers. Increases in organizational concentration predict improvements in diabetes care and are not associated with greater use of emergency department or inpatient care.

Organization level research in scientometrics: a plea for an explicit pragmatic approach

The general aim of this paper is to come to terms with the organization and organization level research in scientometrics. Most of the debate on the issues that revolve organization level research in scientometrics is technical. As such, most contributions presume a clear understanding of what constitutes the organization in the first place. To our opinion however, such “a-priorism” is at least awkward, given that even in specialist fields there is no clear understanding of what constitutes the organization. The main argument of this paper holds that performing organization level research in scientometrics can only proceed by taking a pragmatic stance on the constitution of the organization. As such, we argue that performing organization level research in scientometrics (i) requires both authoritative “objective” and non-authoritative “subjective” background knowledge, (ii) involves non-logic practices that can be more or less theoretically informed, and (iii) depends crucially upon the general aim of the research endeavor in which the organization is taken as a basic unit of analysis. To our opinion a pragmatic stance on organization level research in scientometrics is a viable alternative to both overly positivist and overly relativist approaches as well as that it might render the relation between scientometrics and science policy more productive.