ABSTRACT
Healthcare organizations are spending hundreds of billions of dollars on marketing, advertising, and promotional efforts aimed at attracting new customers, while many of the existing customers routinely slip away through the back door. This is like a metaphorical leaky bucket, with much of the emphasis on the volume of water being poured into the bucket, while continuing to ignore the substantial leak. Little or no effort is made to seal the leak. In managed care organizations, it is not uncommon to speak of disenrollment figures of anywhere from 2 to 25% per month. Hospital patients are asking their physicians not to send them back to certain hospitals, some managed care members are asking not be sent to certain hospitals, and some homebound patients are urging their physicians and legal guardians not to do business with certain home healthcare agencies.
