The changing structure of the health care delivery system in the United States

The historical equilibrium of the health care industry has been disturbed by recent and radical changes in both the financing of medical services and the structure of the industry. The applicability of antitrust laws to the health field, the use of advertising, and the dismantling of quasilegal barriers, such as certificate-of-need (CON) laws, have made economics of scale and efficiency increasingly important determinants of the size and type of organization delivering health services. Such changes, coupled with those pertaining to the financial incentives facing both patients and providers and emerging excess capacity, have wrought a rapid transformation of the structure of the industry. If hospitals and physicians are to survive, they must be able to anticipate new and increasingly competitive developments. Because competition eliminates cross-subsidies, access to care, especially by the poor, is certain to become more precarious.