System transformation: USA and international strategies in healthcare organisation and policy

This paper draws attention to the US clusters and frames them in the context of regionalisation. It does this in three steps. First, it highlights key moments in US history in which regionalisation emerged as a central albeit unsuccessful policy strategy. Second, it considers how the strategic moves of multi-hospital systems contributed, especially in the 1990s, to the formation of hospital clusters. And third, it provides a broad overview of regional system formation internationally. The paper concludes that greater priority in both policy and research needs to be given to the provider clusters that now spread across this country's healthcare landscape.