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The head of the Clinical Resource Management Committee at St Catharines General Hospital which was responsible for monitoring and promoting optimal resource utilization by physicians and the other staff at the hospital. While the committee had made some gains, there was little effect on the hospital''s operating costs and many physicians were uninterested or resistant to the concept of utilization. In addition, hospitals in the region were faced with restructuring proposals and budget cuts in the near future. The case highlights the changes taking place in the health care sector and the implications for managerial analysis and control. Issues covered include: cost analysis, design of a funding scheme to promote certain behavior, data collection and validity, incentives, and performance measurement.