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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 ONeill 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 
communitys 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 HSCs 
12 intensive study sites since the organizations 
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 HSCs 
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 todays 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. ONeil, 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. 
  
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