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Snapshots of Change in Fifteen Communities:
Hospitals in a Changing Health Care System
Summer 1996
Health Affairs, vol.15, no.2 (Summer 1996): 49-61
Kathryn Saenz Duke
ealth system change is happening locally, and hospitals are at the
center of this change. This paper, which presents data from a 1995 study of 15 diverse
communities, sketches the broad economic and organizational forces affecting hospitals in
these communities and the hospitals responses. Within these larger trends, local flavors
and differences emerge. These appear to reflect variations in each communitys employment
base and health care purchasing experience, in the history and political strength of
health system stakeholders and in regional issues of culture or religious affiliation for
some hospitals
Free access to this article is available at the Health
Affairs Web site.
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