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They're bright, focused and aggressive. They're on a mission to improve the quality of America's healthcare provider organizations. They're MODERN HEALTHCARE's 1996 Up & Comers, a dozen healthcare professionals 40 and younger who are in the vanguard of the next generation.

This special section marks the 20th anniversary of Crain Communications' ownership of Modern Healthcare. On the following pages, the staff of Modern Healthcare examines the three most important developments of the past two decades (p. 44) and then reviews in detail the news events, trends and people that shaped each year (pages 46-84). A compilation of some of the best work of editorial cartoonist Roger Schillerstrom can be found on p. 86. Finally, with the help of healthcare futurists, we'll take a peek at the next 20 years of healthcare (pages 92-96) as this most changeable of industries undergoes ever more profound transformations.

In 1995 investor-owned systems balanced cutbacks and profits, while not-for-profits suffered at the bottom line. Psychiatric hospital systems saw more upheaval, and outpatient and post-acute care grew at a steady pace. And in the senior-living business, the smart money was on assisted living.

Intense competition has manifested itself in a number of Southern markets where historic Civil War battles took place. Like Union and Confederate regiments lining up against each other, once-competing hospitals have fallen in along ownership lines to form two competing systems: one for-profit, the other not-for-profit.