Update on the Nation's Health Care System:

Results From Tracking 12 Communities, 1997-1999

Conference Transcript
November 16, 1999

"All politics is local," House Speaker Tip O’Neill used to say. The same might be said about health care.

hile we commonly refer to an "American health system," closer inspection reveals much variety in the way this country finances, organizes and delivers medicine from city to city and state to state. The nature of local institutions and relationships plays a pivotal role in determining the character of each community’s health care system, although national policies, economic trends and technology clearly also have an influence.

This conference will provide insight into key trends discerned from studying local health systems across the country, based on 12 communities that Center for Studying Health System Change (HSC) researchers have visited recently and are tracking intensively over time. Presenters will provide an overview of the major changes observed across markets over the past two years and an in-depth examination of two topics of particular interest-the strategies of specialty physicians and the changing nature of Blue Cross-Blue Shield plans.

Conference Topics:

The conference is organized in three major parts, each of which includes a presentation of research results followed by commentary and perspective by an expert practitioner. Each part of the conference will have ample time for audience Q&A. At the end of the conference, Paul B. Ginsburg, Ph.D., president of HSC, will moderate a discussion among the experts that includes reflection on the implications of the changes and trends presented as well as commentary on what the future may hold for the American health system.

• The first presentation, by Paul B. Ginsburg, will focus on how consumer desire for broad choice of providers and other factors have shaped the evolution of managed care and other sectors of health care delivery. This presentation will emphasize the most salient changes observed in HSC’s 12 intensive study sites since the organization’s initial visits to the communities in 1996 and 1997. Jeff Goldsmith, Ph.D., president of Health Futures, will provide commentary and perspective on this paper.
  
  
• The second presentation, by Jon Christianson, Ph.D., professor at the Carlson School of Management, University of Minnesota and consultant to HSC, will be based on his analysis of the strategies specialty physicians are using to respond to changes in local health care markets and the implications of those strategies. The presentation will focus most directly on trends in organizational strategies-including mergers of single-specialty groups and the establishment of freestanding ambulatory surgery centers-and how they are similar and different across HSC’s 12 communities. J.D. Kleinke, M.S.B., chairman of Health Strategies Network, Inc., will provide additional perspective on this presentation.
  
  
• The final presentation will be by Joy M. Grossman, Ph.D., associate director at HSC, and will focus on Blue Cross-Blue Shield plans, which are notable as the leading health plan in many communities across the country. This presentation will focus on the comparative strengths and weaknesses of the Blues in today’s health care markets, how the Blues are shaping local markets and responding to local market forces and what the future may hold for these plans. Edward H. O’Neil, Ph.D., M.P.A., director of the Center for Health Professions, will comment on this paper.

Who Should Attend:

• Policy makers who need to understand what is shaping and driving recent, national health care trends and what the future might hold
  
  
• Health care industry leaders who would like to understand how local markets are similar and different on key dimensions, and what forces are influencing how these markets evolve
  
  
• Association executives who need to have a nuanced understanding of what is changing in health care markets across the country and why
  
  
• Researchers who would like a current, national perspective about changes and trends in the health system, which are grounded in information collected at the local level.