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The CBO suspects that structural changes, including the shift of services from hospitals to clinics, have helped slow the growth of Medicare spending.But there is much more work to do.
Other smaller IT-services companies, such as BearingPoint and Capgemini, may also struggle with the shift of services abroad.Most services in the middle layer, however, are likely to move offshore at a fairly manageable speed.
In 2003 the government began paying benefits and pensions directly into bank accounts as well as into postal accounts, and this year the BBC stopped selling television licences through post-office branches.This shift of services has trimmed annual income across the post-office network by more than £400m, according to some estimates.
Reports of higher quality care by higher-volume secondary care providers have fuelled a shift of services from smaller provider units to larger hospitals and units.
There has been an increasing shift of services and resources from inpatient hospital settings to settings based on outpatient community and primary care.
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Another Republican, Gov. Mitt Romney of Massachusetts, tried to dispel the perception that his party saw the shift of service jobs from the United States to other countries as part of some global economic strategy.
Most of the emergent models in OASPT involve a shift of service delivery from a traditional hospital outpatient setting to community settings and many harness electronic support.
Gatwick lost more than half its connecting traffic in the decade from 2000, as a result of British Airways abandoning its dual-hub model, and the shift of transatlantic services to Heathrow.
The context was, specifically, the National Health Service (NHS) in the United Kingdom; at the time, the NHS was undergoing reorganisation that favoured a general shift of health services from secondary to primary care.
During the last decade a shift of some services from secondary to primary care has tended to occur, the rationale being to make better use of health care resources [ 17].
This evidence indicates that the neonatal mortality rate in areas with large hospitals was significantly lower than predicted, despite the shift of childbirth services to local community hospitals during the SARS epidemic.
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