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A. Why Sick People Aren't Going to the Hospital

Robinson: For most of this century the hospital has been the center of the health care delivery system in most communities. And that is rapidly changing.

Narrator: : : This is Science Today. Health economist James Robinson of the University of California, Berkeley says that more and more, sick people aren't going to the hospital. Hospitals are expensive, and HMOs, which are becoming the most common form of health insurance, are doing their best to reduce costs.

Robinson: And the effect of that is to reduce the role of the hospital, and now in fact I think it's fair to say that the hospital is no longer the center of the delivery system, especially in California. The organizing center, if you will, or center of coordination of the delivery system is some combination of the medical groups -- physician organizations -- and the health plans themselves, such as HMOs. Neither of which are encumbered with a lot of bricks and mortar -- big buildings, expensive machinery and all of that.

Narrator: : And while the change to physician organizations is most evident in California, Robinson says that in health care, as in most things, that state is setting the trend. For Science Today, I'm Steve Tokar.