ACCOUNTABLE COMMUNITIES - HOW NORMS AND VALUES AFFECT HEALTH SYSTEM CHANGE

Economic forces, policy initiatives, and technological change push mar kets along what some hypothesize is a common evolutionary path. Observ ations from twelve sites, however, indicate that the pace and directio n of change are highly variable across markets. Other forces, internal and unique to a community, help to explain this variation. These forc es emanate from the underlying history, culture, and values of a commu nity and in part dictate the response of various players to the more c ommon forces, This paper explores the mechanisms through which these f orces operate and their relationship to health system change.