Hospital-physician relationships: a hurdle on the road to reform.

T hroughout the summer, federal plans for healthcare reform continued to stall, to the chagrin of many in the healthcare and policy communities. Even within the Clinton administration, the tension was apparent between the desire to forge ahead and the need to wait for a politically appropriate moment to unveil the health reform planafter the president's economic package and budget have passed. Despite delays ill Washington, many in the healthcare community believe reform must and will move ahead in the private marketplace and at the state level. Catholic Health Association (CHA) President and Chief Executive Officer John E. Curley, Jr., commented in an interview: "I think health policy reform, especially on the delivery integration front, is going to occur regardless of what happens in Washington." Reforming healthcare delivery via integrated delivery networks (IDNs) is the centerpiece of CHA's reform strategy. At its annual meeting in June, CHA unveiled a draft of its Handbook for Planning and Developing Integrated Delivery, a resource it will release in O c t o b e r to help Catholic facilities push ahead with systemic reform. For CHA, the IDN strategy "is both a necessary antidote to the nation's increasingly dysfunctional delivery system and a way for Catholic healthcare providers to give contemporary expression to their mission, values and ministry."'