In the current period of rapid change in the structure, financing, and governmental oversight of the health care delivery system, two types of health care organizations may be the most vulnerable: public hospital systems and academic health centers (AHCs). Both types of organizations must cope with unprecedented pressures to reduce costs. AHCs are especially likely to be high-cost providers of health services—25 to 40 percent higher, in fact, than non-academic centers. AHCs face decreases in traditional sources of revenue such as federal support for graduate medical education (GME); increased efforts to move GME outside the hospital setting; greater competition for new funds for biomedical research; and rising numbers of uninsured patients.