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Payer-Provider Role Conflict in Municipal Safety-Net Health Systems

PAM, Vol. 16 No. 1, (2011)

Little scholarly attention is paid to inherent conflict in safety-net health systems in which local governments both finance and deliver health services. In this paper, four typologies of role conflict are used to describe and illustrate role incompatibility in the Los Angeles County Public Safety-Net System and other municipal Safety-Net Health Systems which act as both payers and providers of health care. By connecting the dots between the potential negative outcomes conceptually illustrated in the case study and similar outcomes in empirical studies on Los Angeles County, the study suggest that the existence of role conflict in Municipal Health Care Systems can have negative effects on provider job satisfaction and the quality of health services. Governance, policy, and organizational context remedies are recommended to address potential ills of role conflict. Future directions for research are also suggested.

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