Abstract
Teams of researchers visited fifteen communities--selected to reflect a range of health care market development, regions, and population size--to obtain a "snapshot" of health system change. The study found that organizational change is pervasive, even in those communities that do not receive attention in the trade press, but that much of the change has not yet affected consumers. While the forces driving change are similar across the communities, the responses--and the shape of change--differ in important ways. Factors leading to the differences include the size and capabilities of existing health care organizations, the community's experience with managed care, and the political and business cultures of the community.

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