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Return to sender: Unraveling the role of structural and social network ties in patient sharing networks


  • Westra, Daan
  • Makai, Peter
  • Kemp, Ron


Healthcare is increasingly delivered through networks of organizations. Well-structured patient sharing networks are known to have positive associations with the quality of delivered services. However, the drivers of patient sharing relations are rarely studied explicitly. In line with recent developments in network and integration theorizing, we hypothesize that structural and social network ties between organizations are uniquely associated with a higher number of shared patients. We test these hypotheses using a Bayesian zero-dispersed Poisson regression model within the Additive and Multiplicative Effects Framework based on administrative claims data from 732,122 dermatological patients from the Netherlands in 2017. Our results indicate that 2.6% of all dermatological patients are shared and that the amount of shared patients is significantly associated with structural (i.e. emergency contracts) and social (i.e. shared physicians) ties between organizations, confirming our hypotheses. We also find some evidence that patients are shared with more capable organizations. Our findings highlight the role of relational ties in the way health services are delivered. At the same time, they also raise some potential anti-trust concerns.

Suggested Citation

  • Westra, Daan & Makai, Peter & Kemp, Ron, 2024. "Return to sender: Unraveling the role of structural and social network ties in patient sharing networks," Social Science & Medicine, Elsevier, vol. 340(C).
  • Handle: RePEc:eee:socmed:v:340:y:2024:i:c:s0277953623007086
    DOI: 10.1016/j.socscimed.2023.116351

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    References listed on IDEAS

    1. Lee, B.Y. & McGlone, S.M. & Song, Y. & Avery, T.R. & Eubank, S. & Chang, C.C. & Bailey, R.R. & Wagener, D.K. & Burke, D.S. & Platt, R. & Huang, S.S., 2011. "Social network analysis of patient sharing among hospitals in Orange County, California," American Journal of Public Health, American Public Health Association, vol. 101(4), pages 707-713.
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    4. Westra, Daan & Angeli, Federica & Jatautaitė, Evelina & Carree, Martin & Ruwaard, Dirk, 2016. "Understanding specialist sharing: A mixed-method exploration in an increasingly price-competitive hospital market," Social Science & Medicine, Elsevier, vol. 162(C), pages 133-142.
    5. Mascia, Daniele & Angeli, Federica & Di Vincenzo, Fausto, 2015. "Effect of hospital referral networks on patient readmissions," Social Science & Medicine, Elsevier, vol. 132(C), pages 113-121.
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    7. Eva Kesternich & Olaf Rank, 2022. "Beyond patient-sharing: Comparing physician- and patient-induced networks," Health Care Management Science, Springer, vol. 25(3), pages 498-514, September.
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