The determinants of integrated primary health care organisations: an empirical study of local health care co-operatives. by

Acknowledgements The authors are indebted to the Information and Statistics Division of NHS Scotland for its cooperation in providing the data used in this study. Thanks are also due to John Cairns and Robert McMaster for helpful comments on earlier drafts of this paper. HERU is funded by the Chief Scientist Office of the Scottish Executive Health Department (SEHD). The views expressed in this paper are those of the authors and not SEHD.Summary Following the 1997 U.K. health care reforms, general practitioners can decide if and how much to integrate with organisations of general practices. This paper examined the reasons that general practices have for working together within integrated primary health care organisations in Scotland, i.e. local health care cooperatives (LHCCs). A pluralistic framework of the determinants of membership and involvement in LHCCs was derived from the economics and health care literature. Data were obtained by means of two anonymous postal questionnaire surveys of all Scottish LHCC practices and non-participating practices, and analysed using limited dependent variable regression techniques. Collaboration among health care providers, supporting the delivery of health care, and providing better quality of care were identified as key reasons for integrating with an LHCC. However, issues relating to costs of organisational change, inequity between general practices that had integrated and those that had not, and loss of autonomy and decision making power adversely affected integration. The extent to which a general practice integrated with an LHCC depended on the LHCC that the practice had joined. Therefore, policy needs to focus on strengthening the organisation and management of LHCCs to stimulate integration of general practices with LHCCs.