The formation of health insurance purchasing alliances in Minnesota has caused a restructuring of the provider system. One of the results has been the formation of competing delivery systems that organize hospitals, physicians, and insurance plans into vertically and horizontally integrated organizations termed integrated service networks (ISNs). This article describes the formation of these ISNs and identifies some of the salient features that distinguish them from other provider systems.
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Kralewski et al. (1995) studied this question.