  
	
  
Snapshots of Change in Fifteen Communities:
Health System Integration: A Means to an End
Summer 1996 
Health Affairs, vol.15, no.2 (Summer 1996): 92-106 
 Robert  Miller 
 he creation of integrated firms and contractual networks in health
    care often is a precondition for other forms of integration that could actually lower
    costs and improve quality of care. Although different types of integration activities are
    leading to innovations in the production of services and the care of populations, the
    continued influence of the "old" indemnity insurance/fee-for-service system
    creates important obstacles to those integration activities. If creation of integrated
    firms and contractual networks races ahead of other forms of integration, it could produce
    noncompetitive markets that reduce pressures to integrate in ways that can cut costs and
    improve quality of care. Purchasers actions could play a major role in determining the
    future of various integration activities.  
 Free access to this article is available at the Health 
  Affairs Web site. 
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