Regional systems face organizational development challenges to integration.

Luke concludes his article by recommending regional system formation be permitted, even encouraged. I certainly agree with that encouragement and also agree that demonstration and evaluation projects should be initiated to determine what works and what does not work in regional system development. At the present time that information is gathered and shared on an ad hoc basis through alliances of systems, such as American Healthcare Systems. Although this ad hoc mechanism is useful, it needs to be supplemented with more research, policy initiatives, and structured evaluations. Luke has made a positive contribution with his national study, and more work of this nature will aid the development of regional systems across the United States.