The hospital support game revisited.

This paper updates a well-known case study in which Ray Elling examined the failure of community health planning in a medium-sized American city. During the period described by Elling, the city's hospitals had managed to resist efforts to rationalize the system by marshalling the support of their respective constituents. This political gamesmanship gave way in the late sixties and early seventies to greater cooperation and a significant consolidation of the hospitals. The authors hypothesize that an important factor influencing this development was the change in medical technology. The effects on the community's health care delivery are also discussed.