Cooperative health purchasing organizations are included in almost all the key federal legislative proposals to reform the U.S. health care system. Although certain characteristics of alliances in President Clinton's proposal, particularly their size and regulatory rules, have been the subject of much criticism and seem certain to be changed by Congress, virtually all of the alternative proposals still assign a health plan puchasing role to alliance-like structures. Thus, an analysis of alliance issues and options is still fully relevant to the debate on health systems reform.

This report was developed for the Henry J. Kaiser Family Foundation.