Power and new economic relationships.

We are going through a transformation of our health services from a community and patient focus fueled by fee-for-service and cost-plus reimbursement. This transformation, called managed care, is shifting power away from professionals and communities into both new and old organizations financed by Wall Street. Even traditional community organizations are driven by Wall Street-dictated financial ratios that represent scoreboards to determine who gets capital for growth and development. Times are changing, organizations are changing, and still more change is ahead.