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Accountable Communities:

How Norms and Values Affect Health System Change

July/August 1998
Health Affairs, vol.17, no.4 (July/August 1998): 149-157
Caroline Rossi Steinberg, Raymond J. Baxter


conomic forces, policy initiatives and technological change affect market evolution. The pace and direction of that change vary across markets, and other forces unique to communities help explain the variation. These forces arise from underlying community history, cultures and values and in part dictate the response of various players to common forces, which include: pressure from purchasers to reduce prices; the shift to managed care in the public and private sectors; excess capacity; technological developments; and state and federal policy initiatives. These forces drive market consolidation, change the locus of risk management and alter the relationships between providers and patients and between providers and their communities.

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