Mergers versus Emergers: Structural Change in Health Care Systems
Brenda J. Zimmerman, York University
Kevin Dooley, Arizona State University

Published in Emergence, 2001 vol 3, no. 4, pp 65-82
Please reference Emergence if quoting from the paper

Structural changes are commonplace in modern health care systems. Mergers, alliances, networks and other forms of structural change are being undertaken to reduce costs, improve utilization and service breadth, and reduce variation in demand.

While some of these changes have provided benefits to both the health care provider and consumers, many have failed to reach their full potential, or worse.

In this paper we propose that mergers and other structural changes are a rational response to market pressures, under the assumptions of the currently dominant, mechanistic business model of health care. Most mergers are primarily aimed at exploiting existing knowledge and capability. Synergy is thought of only as a deterministic phenomenon, something that can be created and managed.

We next present a biologically based model using complexity science that illustrates the broader, explorative role that mergers based on the principles of self-organization could have. First, these self-organizing mergers-we call them emergers-could focus on much broader objectives than merely reducing costs. Second, emergers could be used to innovate radically different configurations of our health care system. Building on the first two roles, we see a third role that challenges the fundamental assumptions of what health care is, what it could be and how it could be delivered.