Health care in the 1990s: a buyer's market.

The successful health care organization of the 1990s will evolve from the changing relationships between buyers, providers, and consumers of health care. Under the traditional fee-for-service system, the interests of the three groups were often in conflict. As buyers, primarily government and private purchasers, become more involved in the health care industry and demand cost reductions, relationships between buyers, providers, and consumers will be substantially different. Health care organizations that hope to survive and prosper will need to develop new skills such as performance standards, risk-sharing arrangements, and selection and pricing criteria for this changed environment. They will also need to become involved in all aspects of the provision of health care, with responsibility for management, marketing, and maintaining quality while controlling money, services, and promises. Buyers will increasingly demand certain features from health care organizations, including flexibility in benefits and financial arrangements; controls on price and utilization of services; monitoring the quality of care; and financial stability. Organizations that come close to this ideal are likely to become a dominant force in the health care field.