Health care institutions in a regional network: A longitudinal case study of inter-organizing

This is a second article reporting on the functioning of a regional federation in the Dutch health care field. It is a heterogenous federation of health care delivery institutions (clinical, ambulatory, and primary care) within a geographical area of about 250,000 inhabitants. The first article on this subject, published in this journal in 1981, dealt with the facilities and obstacles during the founding process of the federation and with the problems concerning the making of a policy program [1] (Soc. Sci. Med.15A, 41-48, 1981). That was about five years after the inception of the federation and it seemed both possible and fruitful to carry out further evaluation of this particular case. A content analysis of all the 41 meetings of the federation could be performed on the agendas, minutes and other relevant documents. The results of this analysis, taken together with a substantial amount of information gathered by participant observation during these sessions, gave rise to certain conclusions and interpretations. They concerned the numbers and kinds of subjects discussed, the changes in their composition over the years, the varying amount of energy put into the development of the federation's organization, the evolution of the federation's task and its effectiveness in preparing regional plans for health care provision. The results of the analysis seemed to encourage thisapproach to regionalization. Developments during the most recent period, since 1982, will be described in a third article. Although in a legislative sense this year was important, the related enactment processes went on very slowly. Only a few regions are currently in an experimental stage, among them the region we shall consider, this being one which increasingly succeeded in its attempts toward inter-institutional co-operation.