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The Chairman of the Board of the Tartu University Clinics Foundation reflects on the changes his institution has undergone in the last few years. The 17 clinics that existed under the Soviet system have been brought together under the Tartu University Clinics Foundation and now have a unified organization with a Governing Council that includes government representatives. The dual managerial structure (reporting to the Ministry of Higher Education as a teaching institution, and to the Ministry of Social Affairs as a health care provider) has been combined in a single structure, and systems have been put in place to foster efficiency and create an internal market among the clinics. And all of this has been accomplished while reducing the number of hospital beds, shortening the average length of stay, and reducing the number of employees.