This paper begins by considering briefly the interdependent nature of the health care sector and suggests that most research on structural change in the hospital system has ignored that obvious fact. It then goes on to argue that this failure will become even more significant in the face of the large scale changes that are expected in the way health services are delivered. Its central proposal is that the research horizons should be widened, particularly if change on the scale that appears likely is to be properly evaluated. How that may be done is considered in the final section.
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