利用者:Qiluevqjed

Big chains thrive because they provide goods and services of greater variety, better quality, and lower cost than would otherwise be available... Size is the key. It gives them buying power, lets them centralize common functions, and allows them to adopt and diffuse innovations faster than they could if they were a bunch of small, independent operations. Such advantages have made Walmart the most successful retailer on earth. Pizza Hut alone runs one in eight pizza restaurants in the country. The Cheesecake Factorys major competitor, Darden, owns Olive Garden, LongHorn Steakhouse, Red Lobster, and the Capital Grille; it has more than two thousand restaurants across the country and employs more than a hundred and eighty thousand people. We can bristle at the idea of chains and mass production, with their homogeneity, predictability, and constant genuflection to the value-for-money god. Then you spend a bad night in a "quaint" "one of a kind" bed-and-breakfast that turns out to have a manic, halitoxic innkeeper who cant keep the hot water running, and its right back to the Hyatt.

Medicine, though, had held out against the trend. Physicians were always predominantly self-employed, working alone or in small private-practice groups. American hospitals tended to be community-based. But thats changing. Hospitals and clinics have been forming into large conglomerates. And physicians-facing escalating demands to lower costs, adopt expensive information technology, and account for performance-have been flocking to join them. According to the Bureau of Labor Statistics, only a quarter of doctors are self-employed-an extraordinary turnabout from a decade ago, when a majority were independent. Theyve decided to become employees, and health systems have become chains...

Im no exception. I am an employee of an academic, nonprofit health system called Partners HealthCare, which owns the Brigham and Womens Hospital and the Massachusetts General Hospital, along with seven other hospitals, and is affiliated with dozens of clinics around eastern Massachusetts. Partners has sixty thousand employees, including six thousand doctors. Our competitors include CareGroup, a system of five regional hospitals, and a new for-profit chain called the Steward Health Care System.