COMMUNITY EXPERIMENTS IN ACTION - DEVELOPING COMMUNITY-DEFINED MODELSFOR RECONFIGURING HEALTH-CARE-DELIVERY

In the United States, health system change occurs as the interaction o f politics and policies is played out and pushed forward by individual s and organizations taking action in their local communities and marke ts. This article provides context and descriptive information about a model of local health care reform that is being tested in twenty-five communities around the nation. We introduce a value-based model of com munity-responsive health system change, the Community Care Network (CC N) Vision. We briefly describe a national demonstration program that i s testing this model between January 1996 and the end of 1998. We offe r several ways of looking at the local and regional multisectoral part nerships that are attempting to demonstrate the CCN vision. We look at their composition, the kinds of actions in which they are engaged, se veral example challenges and responses to them, and we give several ex amples of schools becoming part of the health system of last resort. F inally, we present some early ideas on how the local actions described here may influence (and be influenced by) the political and policy co ntexts in which they occur.