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Perhaps there is another angle. The demand for healthcare is a mixed bag. All organisations need to survive financially. Mix these two drivers and you have the recipe for both failure and success. Failure looks like carving the system into profitable-and Unprofitable chunks - and guess who is going to compete for the former and who will be saddled with the bill for latter? Success might just look like steering clear of carve-out and learning to improve both. It is possible because it has been done.