Despite the explosive growth of the nonprofit sector in recent years, many charitable organizations have closed their doors. Evolution of the health care delivery system in the Minneapolis-St. Paul metropolitan area in Minnesota has favored large, integrated service networks at the expense of small, church-based nonprofit organizations that have long served as a means of neighborhood organizing, social outreach, and the proliferation of community values. Interviews with three defunct church-based health care organizations provide the basis for the authors' observations that relatively sudden and wide-scale changes in the health care environment have legislated against small health care organizations, selecting them out for extinction.
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