In addition, to ensure an efficient delivery of care these providers should be large enough to operate efficiently.
But the broader issue is the ability to operate efficiently.
Exactly how much it will need to wrest from its unions to operate efficiently is unclear.
The risk is that there is no discipline to force them to operate efficiently.
The Chicago plant, parts of which date from the 1920's, is too old to operate efficiently, a spokesman said.
But since the private investors got paid only on net receipts, they had a strong incentive to operate efficiently.
As a result, airports and air traffic control have neither the flexibility nor the incentives to operate efficiently.
One author argues passionately that American companies require loyal employees to operate efficiently, and that means shunning layoffs.
He said county officials in the past eliminated jobs but failed to re-engineer agencies to operate efficiently without those workers.
President Bush opposes price controls because he says they do nothing to increase supply while interfering with the market's ability to operate efficiently.
Peter Roberts, the former naval commanding officer now a senior research fellow at RUSI, said the ships were still able to operate efficiently.
