How the U.S. Health Care System Was Transformed

Conference on changes in health care politics, policy, and markets in the nation, states, and communities

In 1996, the editorial office of the Journal of Health Politics, Policy and Law, located at the University of Pittsburgh Graduate School of Public and International Affairs, organized a conference that covered three arenas:

  • The health care market.
  • The states and health policy.
  • The role of communities and lessons for the future here and abroad.

Key Results

  • The conference, entitled "Health Care into the Next Century: Markets, States, and Communities," took place on May 3–4, 1996, in Durham, N.C.

    The first part of the conference examined the transformation of the health care system from small group, or solo, fee-for-service medical practices and largely nonprofit hospitals and health plans to physicians in large, multispecialty groups under managed care arrangements, and competition among for-profit managed care plans.

    The second part considered how states are performing as centers of major health care policy initiatives, especially in health care coverage and cost control.

    The third part considered the role of community—what community means and what community leaders and members can do to affect health care—in a system increasingly dominated by market imperatives and large-scale, regional delivery systems.

    The closing segment addressed the impact that learning from market-based experience is likely to have on future health policy making and the significance of US experience for policymakers abroad.

    The conference drew 119 attendees from 25 US states and the District of Columbia and from four other countries:
    • About half were affiliated with universities.
    • Fifteen percent with think tanks, independent research centers, or nonprofit agencies.
    • Eight percent with various interest groups.
    • Seven percent with nonuniversity clinical or medical settings.
    • Twelve percent with the government.

Further Dissemination

  • Revised conference papers were published in three special issues of the Journal of Health Politics, Policy and Law, entitled "Health Care into the Next Century: Markets, States, and Communities" ("Part I: Legacies an Markets," April 1997; "Part II: States—the Policy Crucible," June 1997; and "Part III: Community and Learning," August 1997).
  • Two other conference papers were published in the Journal of Health Politics, Policy and Law in 1998.
  • Selected conference papers were revised into a book of essays entitled Healthy Markets? The New Competition in Medical Care (Duke University Press, 1998).
  • Mark Alex Peterson is working on editing a second book, tentatively entitled Health Care and Community, that would include updated versions of the community-related papers from the conference.


The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $49,852.

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