Thesis Title: Assessing the Feasibility of Medical Practice Franchises in the Current Policy Environment
Bibliographic record
Abstract
The state of the healthcare system in this country, most would agree, is tumultuous. The United States spends the most and has the least effective medical care among all developed countries, and three-fourths of our population believe we need major, potentially reconstructive changes to our healthcare system. Specifically, this thesis investigates the franchise model, a business format praised for its efficiency, and its potential utilization to deliver a standard, high quality of health care to populations across the country. The franchise model is a method for expanding a business by opening identical, chain-like operations in various locations and distributing services through a licensing relationship. The franchisor, the licensor, grants a license to the franchisee to conduct business under the brand and trademark of the franchisor. A franchisee generally operates one location, or unit, and reports back to the franchisor in this contractual relationship. While the number of medical practice franchises that currently exist worldwide varies due to the rapid entry and exit of firms in this market and the lack of documentation for many firms, the estimated number is two-hundred firms. Based on the same sources, the approximate distribution is 75 medical practice franchises in the United States and Canada, 45 in Europe, and 80 in Asian and African countries. Despite this quantity, very little literature documenting the evolution, nature and environment of these organizations exists. . Despite this quantity, very little literature documenting the evolution, nature and environment of these organizations exists. As medical practice franchises are a unique delivery format at the intersection of business and medicine, understanding the purpose and structure of these organizations and their evolution in the healthcare sphere is of great importance, especially in a time of high demand for better healthcare delivery solutions. In a period of increasing provider consolidation driven by payment reform, the franchise model offers an alternative for physicians who want to maintain autonomy. This thesis attempts to describe the nature, environment, and trends of medical practice franchises using a structured electronic search. Two theories of organizational environment are used to help frame this analysis: resource dependence theory and institutional theory. The three foci of this thesis are: A. To describe key organizational trends of the medical practice franchise within published industry reports, scholarly literature, and news reports on medical practice franchises and medical care organizations. B. To describe the organizational environment of medical practice franchises in the United States, especially the legal and regulatory policies impacting medical practice franchises. C. To explore the utility of institutional theory to explain variation in the development of medical practice franchises in the United States.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.027 | 0.135 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.004 | 0.005 |
| Scholarly communication | 0.012 | 0.009 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.003 | 0.005 |
| Insufficient payload (model declined to judge) | 0.014 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".