In part, the latest shift is simply a matter of speeding the process of change spurred by managed care and other cost-containment efforts.

"The cost-containment efforts are entirely rational and as expected," he said.

But it is clear that the traditional politics that have blocked past cost-containment efforts may be difficult to overcome.

The company attributed its results to higher prices for tobacco and foods, improved operating efficiencies and cost-containment efforts.

In fact, the effectiveness of cost-containment efforts began to wane some time ago.

Earlier this year, the company embarked on a cost-containment effort to save money.

The recent rise in Showboat's stock reflects investors' confidence in the company's marketing strategy and cost-containment efforts at its two casinos.

Researchers say that it is extremely difficult to assess whether cost-containment efforts are directly affecting the quality of care because so many variables are involved.

Between 1981 and 1987, cost-containment efforts have reduced hospital days by 18 percent, so that much of the potential 30 percent reduction in days has already been achieved.

It's just as likely to be a cost-containment effort by procurement or even the manufacturer.