Duke K S
Institute for Health Policy Studies, University of California, San Francisco, USA.
Health Aff (Millwood). 1996 Summer;15(2):49-61. doi: 10.1377/hlthaff.15.2.49.
Health system change is happening locally, and hospitals are at the center of this change. This paper, which presents data from a 1995 study of fifteen diverse communities, sketches the broad economic and organizational forces affecting hospitals in these communities and the hospitals' responses. Within these larger trends, local flavors and differences emerge. These appear to reflect variations in each community's employment base and health care purchasing experience, in the history and political strength of health system stakeholders, and in regional issues of culture or religious affiliation for some hospitals.
卫生系统的变革正在地方层面发生，医院则处于这一变革的中心。本文呈现了1995年对15个不同社区的研究数据，概述了影响这些社区医院的广泛经济和组织力量以及医院的应对措施。在这些更大的趋势中，出现了地方特色和差异。这些似乎反映了每个社区就业基础和医疗保健购买经验的差异、卫生系统利益相关者的历史和政治力量的差异，以及一些医院在文化或宗教归属方面的区域问题。
