Context and catalysts for change in health care markets.

Understanding the nature of change in health care markets involves recognizing that not all communities are alike, and hence not all health care markets look or act the same. In a study of fifteen communities sponsored by The Robert Wood Johnson Foundation, the characteristics and culture of each community interacted with market conditions to influence the magnitude, direction, and sustainability of health system change. A catalyst attuned to a market's context can ignite change, giving the market focus and direction. Recognizing the importance of context to the process of change enhances our ability to understand the consequences of proposed market activities.