This is a comparative analysis of hospitals’ efforts in three communities to pursue collaborative ventures to advance community health. The events occurred over a two-year period characterized by increasing market competition and national debate about comprehensive health carefinancing reform. The study objectives are to better understand factors that contributed to the initiation of the collaborative efforts, and factors that sustained, hindered, or thwarted theseefforts. The study explores how the collaborative ventures in these three communities fared in the face of multiple and conflicting policies and the simultaneous creation of larger, competing health systems. A number of concluding generalizations address the impact of interorganizationaldynamics and public policy initiatives on community health partnerships.