Private-sector health care initiatives: a comparative perspective from four communities.

care services will undergo significant changes during the 1980s, in part as a result of purchaser efforts. This emerging purchaser revolution is largely a consequence of frustration with the past two decades of unrestrained growth in health care costs and a growing recognition by purchasers of their capability and responsibility for controlling health care costs. The existence of this "purchaser revolution" has been the subject of some debate. A frequently cited study of corporate attitudes concluded that the business community was not especially concerned about rising health care expenditures and saw little advantage in taking action to control them (Sapolsky et al. 1981). More recently, Iglehart directed our attention to the awakening of industry-the "slumbering giant"-to a new concern with health