In recent years, health clusters have been limited in their ability to meet the demands and serve the interests of population groups and social segments in a comprehensive manner at healthcare sites within health regions. The reasons for this lay in the low degree of willingness of the stakeholders to deal with the growing challenges and resulting outlooks in healthcare. Questions concerning quality in health clusters were left unasked to give weight to the local and regional effectiveness regarding employment and growth. With the focus on ensuring long-term survival and creating value, the strategies for efficiency were given precedence over the strategies for effectiveness in health regions. For instance, the following questions remained unanswered: How can rural areas be included in the regional area of existing health clusters? To what extent are health clusters dependent on the inter-regional periphery and on intra-regional positioning and self-presentation of the individual stakeholders? Which quality indicators are suitable for health regions to reflect the positioning and self-presentation in order to promote their role in healthcare in order to attract clients?
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