  
	
  
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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