The impact of competitive health care systems on professional education

The development of competitive markets for health services as a cost containment strategy and the attendant shift to the provision of services through large-scale organizations are having a profound effect on academic health sciences centers. At the University of Minnesota, where this transition is firmly in place, the teaching programs based at the University of Minnesota Hospital and Clinic are threatened as health maintenance organizations and similar provider systems restrict referrals to these institutions and limit lengths of stay. Moreover, large-scale provider organizations are becoming more influential in determining the content of the training programs. The University of Minnesota Health Sciences Center is attempting to improve its competitive position in health care delivery and reshape its teaching programs to reflect this new environment through strategic planning.