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December 12, 1986

The Hospital Power Equilibrium: Physician Behavior and Cost Control

Author Affiliations

St Anthony Hospital Columbus, Ohio

JAMA. 1986;256(22):3162-3163. doi:10.1001/jama.1986.03380220128040

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The Hospital Power Equilibrium presents the political forces at work within the hospital environment that hinder cost-control efforts.

The authors' definition of the problem in part 1 is excellent. Today's movement toward a market-based economy is believed to be detrimental to the health care industry. The extensive citations support their thesis through an elaboration of the multidimensional motivations present in today's hospitals. The authors present Crozier's model of organizational behavior—constant conflict with stable outcomes—as being a philosophic framework that one may adapt to the health care setting. Conflicting incentives between physicians, administrators, and other occupational groups are proposed to be the undermining of the present system.

The authors present two case studies in part 2. They adequately defend the selection of this small number by stating that the lesson to be learned is not what happened, but why. The problems inherent in these two institutions give an excellent representation of