This section identifies the services available to ensure the efficient and effective use of resources in the high-quality service of patients.

In the 1980s and early 90s, the dominant success strategy for U.S. healthcare providers was the development of volumes and revenues. This focus on the "top line" of the financial statement resulted in the dramatic growth of specialty programs and services, "centers of excellence", and healthcare marketing. This strategy was, in large part, a response to payer initiatives reducing incremental reimbursement for services without addressing actual utilization. In this environment, increasing volume allowed a provider to continue covering costs at lower rates.

In the mid to late 90s, payers adjusted their strategies and began addressing utilization issues. Managed care became much more common and reimbursement vehicles such as capitation and case-rates were implemented to control the growth in utilization. U.S. providers responded with cost containment strategies, mergers and acquisitions targeting a continuum of services, and by attempting to circumvent traditional payers through the development of provider-owned insurance products.

In the late 90s, focus has shifted, finally, back to the patient. In the U.S. and some other countries with large private healthcare systems, reforms are being implemented that protect the rights of the patient. In Latin America, Europe, and other parts of the world, government sponsored social systems are addressing access and quality issues through investments, privatization, and rationalization. We believe that, in this environment, providers will have to address a comprehensive set of issues, including strategic positioning, volume and revenue growth, and cost containment, but must do it in a model of patient-centered care.