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With U.S. health care costs increasing at three times the rate of inflation and Americans spending 50 percent more on health care than any other nation, health care practitioners will most certainly continue to focus upon cost containment and budgets (Guthrie, 1991). However, as suggested by some experts (e.g. Lytle and Mokwa, 1992), managerial approaches preoccupied with containing costs and financial budgeting are no longer sufficient for success, or maybe even survival, in today's intensely competitive marketplace. The major transformations in structure that have taken place in the health care industry throughout the 1980s call for more proactive and strategic approaches to planning and managing if health care organizations are to be successful in today's highly competitive environment.

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