Kilpatrick, Anne Osborne; Holsclaw, Patricia W.
September 1996
Public Administration Quarterly;Fall96, Vol. 20 Issue 3, p365
Academic Journal
Our nation's health care system has experienced tremendous upheavals since the turn of the previous century. Provision of care--including availability--payment mechanisms, education and training, and methods of delivery, including structure, have all been influenced by changes in funding and methods of leadership and management at the national, state, and local levels. Additionally, the public/private/non-profit debates have enveloped hospitals and health care providers for the last two decades. Efforts to make the provision of health care more "businesslike," efficient, cost-effective, and hence competitive, have resulted in a proliferation of hospitals, skyrocketed increases in technology and its subsequent costs, and the evolution of "managed care." One consequence of this activity is the growing number of uninsured and medically indigent patients, the largest group of whom are children Because of changes in demographics, the growth of the aging population and resultant expansion of chronic diseases as well as the growing disparity between the wealthy and the poor, health care and its administration are among the most turbulent occupations in today's workplace. Challenges for educators and practitioners will include understanding these changes and providing educational and skill training programs to address the ever-evolving and complex health care system. This article presents an overview of the characteristics of our health care environment, the emerging issues affecting delivery systems, characteristics of the evolving health care system, competing tensions affecting administrators and educators, as well as competencies needed by and challenges facing policy leaders and implementers for the future.


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