analysis of hospital mergers over the long term: institutional change

Abstract

Among the various forms of restructuring, the merger has dominated in hospitals since the early 1990s. Although it has not proved its effectiveness in the area of reorganised provision of care, the merger is a process of institutional change. After a period with strong incentives, it seems that cooperating is now preferred to merging. By means of a longitudinal analysis of five merger operations, our article addresses the mechanisms of institutional change at work. We will demonstrate, on the one hand, the contribution of the neo-institutionalist approach in the analysis of the imposed change processes. On the other hand, we will discuss how these approaches outline a vision of performance in health care which is at the confluence of rationality and conformity.