During the past few decades, relationships among healthcare providers at the community level have been characterized by competition and co-operation. Opinions concerning the merits of these approaches vary.
In the United States, the 1970s saw the implementation of health planning, sponsored by the federal government, which stimulated hospitals and other providers to work together to reduce costs and improve care (Hyman 1982). During 2006, in New York State, the Commission on Health Care Facilities revived this approach by encouraging hospitals, nursing homes and other providers to work together to contain costs (Commission on Health Care Facilities in the Twenty First Century 2006). The efforts were based on the assumption that co-operation had the greatest potential for improving care within communities.
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