Update on the Nation's Health Care System:

Originally published by the Center for Studying Health System Change (HSC). HSC was a nonpartisan policy research organization funded principally by the Robert Wood Johnson Foundation.

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 once observed. The same held true for health care. While Americans commonly referred to a single national health system, closer inspection revealed enormous variety in how communities financed, organized, and delivered medicine from one city and state to the next. Local institutions and relationships played a pivotal role in shaping each community's health care character, though national policies, economic conditions, and technological advances clearly also exerted influence.

This conference offered insights into key trends identified through HSC's intensive study of local health systems across the country, drawing on 12 communities that researchers visited regularly and tracked over time. Presenters provided an overview of the major changes observed across markets during the preceding two years and examined two topics of particular interest: the strategies of specialty physicians and the evolving role of Blue Cross and Blue Shield plans.

Conference Structure and Topics

The event was organized in three major segments, each featuring a research presentation followed by commentary from an expert practitioner and audience discussion. The first presentation, delivered by HSC President Paul B. Ginsburg, examined how consumer demand for broad provider choice and related factors had shaped the evolution of managed care and other sectors of health care delivery, highlighting the most notable changes since HSC's initial community visits in 1996-1997. Jeff Goldsmith, Ph.D., president of Health Futures, provided commentary.

The second segment, led by Jon Christianson, Ph.D., of the University of Minnesota and an HSC consultant, analyzed the strategies specialty physicians were using to respond to local market changes and their implications. The discussion focused on organizational trends -- including mergers among single-specialty groups and the establishment of freestanding ambulatory surgery centers -- and how these patterns differed across the 12 study communities.

The final presentation, by Joy M. Grossman, Ph.D., HSC associate director, examined Blue Cross and Blue Shield plans and their notable position as the leading health plan in many communities. This discussion explored the comparative strengths and weaknesses of Blues plans in the current market, how they were shaping and responding to local forces, and what the future might hold. Edward H. O'Neil, Ph.D., of the Center for Health Professions, offered additional perspective.

The conference was designed for policymakers who needed to understand the forces shaping national health care trends, health care industry leaders seeking to compare local markets on key dimensions, association executives requiring a nuanced understanding of market changes, and researchers looking for current, nationally grounded perspectives on health system evolution at the community level.

Sources and Further Reading

Kaiser Family Foundation -- Employer Health Benefits Survey -- Annual data on employer-sponsored health insurance.

Health Affairs -- Peer-reviewed health policy research.

Robert Wood Johnson Foundation -- Health policy research and programs.