Since September 26, when Sen. George Mitchell (D-Maine) officially pronounced health-care reform dead for 1994, each sector of the biomedical research community has been reacting in its own way to the news of its demise. Officials at academic health centers, for example, have been lamenting this year's missed opportunity, while leaders of biotechnology and pharmaceutical firms have been celebrating the congressional reprieve.

Industrial and academic biomedical scientists are increasingly affected by 'competition without the management end'
But regardless of their position on the issue, research administrators in industry and academia agree that the United States health-care market is already driving the system toward reform, even without legislation. And in the two years since Bill Clinton became president, they say, these market-influenced changes have dramatically altered the way virtually everyone in this sector does business.

"The market forces are out there, which are pushing toward the managed competition [and] the HMOs,"...

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