Why do general practices integrate? A quantitative analysis of the factors affecting integration in primary care. by

A quantitative analysis of the factors affecting integration in primary care.Acknowledgements The authors are indebted to the Information and Statistics Division of the NHS Scotland and Matt Sutton for their cooperation in providing the data used in this study. Thanks are also due to (SEHD). The views expressed in this paper are those of the authors and not SEHD.Summary Although many different types of integration in primary care are currently occurring, this paper focuses on local health care cooperatives (LHCCs). These are new types of integrated primary care organisations. Given that LHCC membership is voluntary, general practices can choose whether or not to join an LHCC. This raises the possibility that general practices that have become a member of an LHCC differ systematically from those practices that have preferred to opt out. This study aims, first, to identify the factors that influence a general practice's propensity to join an LHCC and, second, to test hypotheses founded in economic and non-economic theories of the firm about why general practices sign up to LHCCs. The evidence from the logistic regression analysis suggests that four types of factors affect a general practice's propensity to become a member of an LHCC: access to other NHS and local authority facilities, GP workload, population morbidity and deprivation, and history of integration in primary care. Some evidence was found to suggest that a concern for resources increased the probability of LHCC membership, whereas rurality decreased it. These results seem to indicate that general practices respond to the policy of LHCCs in a systematic way and support the existence of selection bias in LHCC membership. Finally, the study illustrated how local factors modify or affect the influence of national policy initiatives.